3.4 Out of pocket payments
NHS care is mostly free at the point of access, but in some cases patients do have to make co-payments (for goods and services covered by the NHS but requiring cost-sharing) and direct payments (for services not covered by the NHS or for private treatment). Some populations, such as children, pensioners over 65 and those on low income, have recourse to reimbursement or exemption for some co-payments, although this varies across the United Kingdom.
3.4.1 Cost-sharing (user charges)
NHS dental care carries a charge throughout the United Kingdom, although exemptions exist for certain populations. In England and Wales a three-tiered charging bands system exists to cap charges for NHS dental care. In Scotland and Northern Ireland patients pay up to 80% of the cost of treatment.
NHS prescription charges in England are set at a flat rate of £8.20 as of 1 April 2014. Exemptions cover a broad range of people, including children under 16 years of age and pensioners over 65 years of age, so that about 90% of all prescriptions were distributed free of charge in 2012, with the majority of those covering medicines for the elderly. Northern Ireland, Scotland and Wales have all abolished prescription charges, although in recent years ministers in Northern Ireland have proposed introducing small charges, with a proposed cap of £25 per year, in order to pay for expensive cancer drugs (O’Neill, McGregor & Merkur, 2012; BBC, 2014a).
3.4.2 Direct payments
Basic ophthalmic services are generally not covered under the NHS. Free eye tests are available to all in Scotland, and to eligible groups such as children and pensioners in England, Northern Ireland and Wales. Eligible patients can also get vouchers to help with the costs of corrective contact lenses or glasses. OTC medicines, by definition, are purchased directly and are not covered by the NHS. Travel costs incurred to get to NHS appointments may be reimbursed, so long as the patient has a referral and meets other conditions related to low income.
In early 2013 the Dilnot Commission provided recommendations on social care changes in England, although these changes have yet to be implemented. The Dilnot Commission recommended a cap on social care costs at £35 000, but the government decided on a cap of £75 000 (BBC, 2013). Local authorities are in charge of providing these funds, but they generally do so when needs are substantial and patients have no assets to draw on. Wales and Northern Ireland have no such cap. In 2002 Scotland abolished charges for long-term personal and nursing care for people aged 65 and older.