Top-up Payments in Cancer Care

Cancer care costs are spiralling out of control in every healthcare environment. Ageing populations with a wide range of medical problems are consuming vastly increasing amounts of care. New technology d drugs, devices and procedures d are powerful inflationary drivers in an information-rich, consumer world. In the era of Google, the old paternalistic medical monopoly of health knowledge is gone forever. Recent research in Birmingham shows that over 50% of newly diagnosed cancer patients in three inner city hospitals had accessed internet information, mostly via their relatives [1]. There is now evidence of a growing use of top-up payments to break access barriers. This applies to areas as diverse as implanted hearing aid devices, access to diagnostics, such as scans, and even home nursing care services. In some areas, for example fertility treatment, this is enshrined in the National Health Service (NHS) by National Institute for Health and Clinical Excellence (NICE) guidance, whereby the NHS pays for three assisted fertilisation attempts but further ones must be self-funded. If successful when self-funded the motherto-be reverts back to the NHS for her antenatal care. Many politicians, whatever their persuasion, have until now been in denial. Meanwhile, cancer patients have learned to become very sophisticated consumers of extra clinical services outside the NHS. Healthcare in Britain has never been totally tax based. Private practice has developed significantly throughout the last 60 years and most of us top-up NHS dentistry and optical services. An ethically driven top-up system is the only sustainable solution for the current challenge of cancer care and carries the best chance of sustaining a high-quality core service for all. Furthermore, it will drive a new, patient-led, competitive marketplace that will create greater efficiency throughout cancer care. Over the last decade, an increasing number of cancer drugs have been licensed. Some are expensive. In the UK, those responsible for commissioning care in the NHS have been increasingly challenged by patients and their relatives to provide new cancer drugs. Over 40 are now in the final stages of the global development pipeline [2]. These are the products of the molecular revolution triggered by the discovery of the structure of DNA in 1953 and the development of remarkable techniques to examine the function of genes, gene expression and proteins. Most of them will receive their market authorisation within the