How should we pay for health care in future? Results of deliberative events with the public

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Part of Time to Think Differently

To contribute to an informed public debate about both the level of future spending on health and social care, and how that spending might be funded, The King’s Fund, in collaboration with Ipsos MORI, held two deliberative events (one in London and one in Leeds) with members of the general public.

Participants were asked for their views on the NHS, the challenges it faces and how it is funded. They were then given information on the funding challenges and offered possible solutions – paying for some services, means-testing or reducing the standard of care. This paper outlines and analyses the responses.

Key findings

  • Participants strongly supported the founding principles of the NHS – that access is based on need rather than the ability to pay, that it is available to all, and of high quality – and wished these to endure.
  • Participants understood how the NHS is currently funded, but welcomed more information about how the money is spent. 
  • If user charges were to be introduced, there was support for applying them to ‘not clinically necessary’ procedures and for needs resulting from inappropriate lifestyle choices or misuse of the system.
  • Means-testing was unpopular both in principle and for practical reasons. However, there was some support for the very rich paying for some services and for voluntary insurance. 
  • Reduction in the quality of care was seen as unacceptable, and paying to secure preferential treatment was strongly resisted, but there was support for optional payment to enhance non-clinical aspects of care (eg, ‘hotel’ facilities).
  • Overall, many understood that the NHS is under pressure, but few accepted that this is on a scale to justify changing the fundamental principles on which the NHS is based.

Policy implications

  • People want to be involved in decision-making about NHS funding; proposals for future change will need to be accompanied by detailed explanation and a public debate.
  • People’s attachment to the founding principles of the NHS and reluctance to amend the current funding model suggest that an incremental approach to change is likely to be more acceptable to the public.


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