In light of pricing influence, another contributory factor governing patient behaviour and decision-making are socioeconomic pressures. A patient in this situation is met with the dilemma of opportunity cost, which equates to making a decision between the choice of obtaining a completed prescription or being short on a personal loan repayment for that month, or having an attenuated shopping budget or skipping a meal. Opportunity cost is the loss of other alternatives when one alternative is chosen. 6
Such a dilemma bears both short-term and long-term consequences. In the short-term, poor health choices are made by patients that result in poor health outcomes. In the long-term, the consequences are not only visited upon the patient they are visited upon the NHS, thus there exists a long-term pharmacoeconomic implication in rising NHS prescription costs in England.
Prescriptions aid with the management or treatment of ailments and disease and can work as a form of preventative medicine, in a more specific fashion than their over-the-counter (OTC) medicines counterparts, in a primary care setting. If we take the example of a simple acute skin infection (cellulitis) of a leg, failure to address this short-term can potentially amount to a significant cost in the long-term. To perform a cost-benefit analysis of treatment within a primary care setting as opposed to treatment in a secondary care setting for such an infection, one would need to consider the following components in their analysis. The cost of 7-day course of treatment with a two-item prescription for a 28 box of flucloxacillin 250mg, four times a day (QDS) and 15g tube of 2% fusidic acid, QDS at a price of £1.67 and £1.92 respectively. 7
Assuming the patient does not present to their GP or opts not to fulfill their prescription and the infection becomes worse, the patient may then be admitted to hospital where upon admission a bed costs on average £222. 8
Once admitted the clinical team will begin a course of treatment involving intravenous (IV) flucloxacillin 2g, every 6 hours QDS at a cost of £6 per 2g vial equating to £24 for a single day of treatment in a hospital care setting. 9&nsp;&nsp;10
In total, treatment at this stage would cost the NHS a minimum of £246 in comparison to £3.59 at primary care. Should the patient continue in prolonging to seek treatment and delay therapeutic intervention through a prescription, the infection can lead to necrotizing fasciitis and in extreme cases surgical intervention would supersede therapeutic intervention in order to improve patient prognosis (in order to avoid death), a single limb amputation would be the treatment of choice.
Surgery of this nature depending on complexity, can range from £5,776- £19,751. 11
These costs say nothing of the aftercare support via NHS occupational therapist, which would set the overall cost soaring. Nevertheless, it demonstrates the vast cost, from just under £4 to almost £20,000, a cost benefit analysis would take have to take this into consideration in its calculation in the treating of a simple infection if caught early in cellulitis. Acknowledging the long-term pharmacoeconomic complications to the NHS, it should serve to galvanise all involved stakeholders to work towards strategies, with the rationale of minimising costs from health complications through a modern and sustainable prescription charge system for England.
On the topic of prescription charges, there exist two schools of thought with opposing arguments. The leading argument for abolishing prescription charges, suggests that such charges create a false economy and is a tax on the sick based on an obsolete and unjust exemptions list that has not been amended since 1968. 12
The leading argument against abolishing prescription charges, propose the reformation of the current exemption list and charging policy, as abolishing prescription charges would cost an estimated £600m. The proposed reformation draws on the findings from the Baker’s Health & Social Care Report Commission, commissioned in 2014. The report acknowledges that a charge of £9 an item was too high, suggested reducing prescription charges by 2/3, and that by reducing the exemptions, but leaving a cap in place for prescription charges, could raise more money than the current charge (this is in accordance to prescription charges in 2014), hence reducing the burden on the less well off who do pay, whilst seeing those who are not currently paying under this system, pay something. 13
Despite these proposals, there may indeed be resistance, namely politically, over the implementation of the suggested removal of a blanket exemption for older people, as this would not be a “vote winner”.
Scrapping prescription charges is the most popular and far easier than reforming the current system, but to do so at the tune of £600m calls for serious consideration. The Barker Report presents a spectrum of options for funding new settlements including charges for healthcare, cuts in other areas of public spending and higher taxation.
Although this approach makes sense theoretically, the practical application of increased taxation would succumb to the same economic fallacies of other economic policies drafted with the utmost altruistic intentions to address short-term issues whilst neglecting the long-term consequences. As American economist Arthur Laffer once said “When you cut the highest rates on the highest income earners government gets money from them”. This theory is best depicted in Laffer’s Curve.