FUNDING THE NATIONAL-HEALTH-SERVICE - THE CONTINUING SEARCH FOR ALTERNATIVES

The article emphasises the urgent need for a reconsideration of potent ial sources of income for the National Health Service which could supp lement rather than replace those from general taxation. They include l ocal taxation, earmark taxes, patient charges (hotel, prescription and other charges for non-clinical items), a lottery, income generation, charitable donations and patient 'opting out' of the NHS with private insurance. Analysis is set within the position statement provided by t he 1989 White Paper Working for Patients and within a more general ana lytical framework paying attention to equity, accountability, value fo r money, management incentives and other criteria. Each funding method is considered in terms of its consistency with the criteria of both t he analytical framework and the White Paper. The differences between s ome of the alternative sources are found to be more apparent than real . Rather than providing a panacea for the perceived funding and ration ing problems of the NHS, the danger is that new supplementary sources of finance may simply replace one set of problems with another. The ne w set may pose even more intractable problems and involve considerable short to medium term disruption of NHS finances. The inescapable fact is that decisions about the levels and quality of public service prov ision and their financing are ultimately matters of democratic account ability, decisions which cannot and should not be sidestepped by the c onvenience of income sources.