The Welsh NHS is facing unprecedented financial pressures and difficult decisions have to be made about how to allocate and use healthcare resources. The aim of this evidence review was to explore whether there are lessons that might be learnt from other countries about how access to healthcare and entitlement can be made conditional in a way that reduces demand for services without having an undue impact on health outcomes.
Drawing on a framework developed by the World Health Organisation (WHO), the available evidence is grouped according to three ‘dimensions’ of ‘coverage’ or entitlement to healthcare: population (who is covered); services (what range of services are covered); and costs (what proportion of the costs are covered).
The financial crisis that struck Europe and the US in 2008 and its consequences has affected healthcare funding in many European countries as their governments have implemented austerity measures, restricting or changing entitlements to healthcare.
Restrictions to entitlements before and after the austerity related changes are most often implemented in the WHO dimension of costs. User charges, particularly co-payments for pharmaceuticals, appears to be the most often used strategy.
Reported experience suggests there are both intended and unintended consequences to cuts to healthcare entitlement and without pro-active safety nets or positive action the vulnerable may suffer financially and health wise.
There is some limited evidence that relatively low co-payments ‘work’ in terms of modifying use/behaviour without disadvantaging certain populations or damaging health, whilst limiting costs.
If changes are to be implemented in Wales it is likely that the drug budget may be more responsive to adjustments to entitlement and that small co-payments or deductibles may bring in revenue without affecting the vulnerable and encourage appropriate consultation and prescribing. Automatic Generic Substitution may be another worthwhile strategy to explore. More in-depth research on these recommendations would be appropriate to determine the best approaches.