Co-payments in the NHS: an analysis of the normative arguments

During 2008, some forms of patient co-payments – in particular, patients paying privately for additional medicines as part of an episode of care in the National Health Service – became controversial in political and policy terms in the UK. In response, the UK Government published a report, the Richards’ Review, examining the issues. Richards offered a particular policy solution, but also touched on fundamental principles of social value. Using the methods of normative policy analysis, we seek to understand these principles of social value, accepting the Richards’ framework according to which the relevant arguments can be grouped under the broad headings of equity and autonomy. None of the arguments on either side are decisive, and, in part, the policy decision turns on uncertain empirical conjectures.