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Comment by tialaramex | Hacker News Reader

Under the NHS most patients pay a "prescription charge" which is intended to encourage patients not to seek prescription meds when they needn't do anything. (Several big categories like pregnant women are exempt from charges, and if you use lots of medicine you can "prepay" a fixed fee of about £100 each year to stop getting charged regardless)

The charge is more than some cheap OTC medicine you might get prescribed, e.g. hay fever tablets are pennies per box and the charge is almost £10. But pharmacists are required to tell you if you could just buy it yourself for less - they collect the charge so they have the opportunity to point this out whereas your doctor needn't know if you pay or not.

Logically the charge must also be bigger than the price for some of the cheapest prescription-only medicine and there's no way to avoid paying extra in the UK as far as I know in this case.

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Over 90% of prescriptions are free, because they're prescribed to exempt groups (children, the elderly, people on benefits). It's a slightly peculiar system that doesn't make a huge amount of sense.

https://www.pharmaceutical-journal.com/news-and-analysis/pre...

Perhaps they could go with a Humble Bundle style "pay what you want" model :) I would happily pay more.

Another exempt group is the chronically ill - if have diabetes or thyroid disease or anything else that requires regular medication you don't pay. It's clear that most prescriptions are written for this group.

The alternative conclusion is that it’s fulfilling its purpose as a deterrent against abusing prescription medication

In Austria it's harder to get exempt. If you rack up 2% of your net income in those charges you can apply for exemption. 80% of Austrians never have been exempt, only 4% sometimes hit the cap and about 12% get an exemption due to specific illnesses which are costly.

I have seen the system here and some of the effects that come out of it are interesting. Because if the cost of a drug falls below the "recipe fee" it bypasses the insurance and is directly charged there is a mysterious amount of drugs close or below the recipe fee.

The charge is more than some cheap OTC medicine you might get prescribed

I've had both similar, and opposite, experience in the U.S.

My wife has a prescription for an OTS drug. Getting the prescription filled with insurance costs $35. But buying it OTC costs $22-25, depending on the store.

I have a prescription for an OTC drug. Getting the prescription filled with insurance costs $3.55. But buying it OTC costs $10-$12.

It's like they always say in health care — ask questions, keep records.

Just thought I would mention in Scotland with NHS Scotland we pay no prescriptions charges.

Defend your public services and safety nets at all costs; vultures await an apathetic electorate.

I think we're 15 years too late to recognise this. We've been pushing healthcare budgets down and into private hands (PFI, tendered provision contracts) for at least that long. And while it's demonstrably failed, we keep pushing that way.

We have too many politicians with too many fingers in too many pies telling too many lies about the "dream" that is American healthcare.

Politicians that can’t be reasoned with can be replaced.

Run for office. Failing that, support candidates that support your views. Democracy exists as a function of effort.

Political will isn't enough. The NHS needs tens of billions to backpeddle years of decline, to re-in-house services and surge-hire staff where they're need with appropriate incentives.

Doing that in a climate of contracting economical growth and leaving the EU (where 40% of our nurses come from) makes this impossible without politically suicidal borrowing.

Raising taxes on vacant real estate owned by non-residents/non-citizens is one option to raise revenue. Russian and Chinese nationals who are using vacant, valuable UK real estate as an asset store don't vote.

We can’t argue the money doesn’t exist. It exists. You just need a majority of people to decide that efficient healthcare is worth paying for.

You're preaching to the choir. I'm not saying it's impossible, just that wanting to do this stuff isn't enough.

Case in point, current opposition leadership would do all this in a heartbeat but between center-leaning members and a very Conservative press, they'll always be portrayed as Nazi-sympathising Communists.

Brexit hasn't helped this either.

I was blown away at the intensity of the propaganda blitz when the Obama administration was working on healthcare - I haven’t seen so much manipulation outside an election cycle. The ‘American healthcare is the best in the world!’ line that was oft repeated stands out to me, since by most objective standards it is far from the best.

The more I read about it the more convinced I am that there is no way to know who is right, both sides are so invested in their arguments and both sides have so many incentives to skew the numbers are play with the outcomes that it's become impossible to get any sort of definitive answer on this.

You say that the US is objectively worse, but I can bring you to 10 people who will argue convincingly that it's objectively better, and then turn you around to 10 people who will convince you of the opposite again. All with real numbers and facts that don't contradict each other.

Then bring this argument. Or don't.

Insisting that "10 people will argue convincingly that four is prime" isn't a convincing argument that four is or even might be prime.

Objectively worse? To what end? What really matters?

Do you care more that your healthcare is 10% more effective at its peak, or that 30% of the population is uninsured, without access to good preventative care? From there you have to extrapolate because nobody can predict the cost of these societal schisms, or that of the cost to heal them.

There is no objectivity to be had here; just morality, hope and fear.

I was sick for years as a growingly impoverished self employed person with no non-emergency healthcare access. This situation is, as far as I know, unique to the US as other countries don’t tie health benefits to private employment.

And if a modest use charge makes the spending more efficient and results in the delivery of more care?

(efficient in terms of medical benefit delivered per unit of spending)

[removed by poster]

My mistake, I thought the thread was about the prescription charges mentioned in the top level comment.

No mistake at all. Subthread went off the beaten path, your argument is still sound. Apologies!

That’s a rather large and unproven if.

If nothing else more complex transactions have higher costs due to the complexity. So, the benifit would need to be rather large and easy to measure to offset this. Until that data shows up it’s rather pointless to argue about.

PS: Also, the effort/tine investment to collect prescriptions is already a modest fee.

Also Wales.

There's also a focus amongst GPs to not prescribe cheaply available drugs, with safeguarding allowances. The NHS pays flat processing fees on classes of drugs. A 10p box of paracetamol ends up costing the CCG £4 to dispense via a high street pharmacy.

This crackdown is at least partially due to the perennial social media posts doing the rounds telling people how to get "free" Calpol for their kids.

Don't forget that prescriptions are free in Wales and Scotland.

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