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Affordability of cancer care in the United Kingdom: is it time to introduce user charges?

机译：英国癌症治疗的负担能力：是时候开始收取使用者费用了吗？

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Context:-udIn high income countries the costs of delivering high quality equitable care are outstripping present budgets. This article reviews the affordability of cancer care in these countries with particular reference to the United Kingdom (U.K.). The question remains as to whether patients should contribute to their cancer treatment through the introduction of user charges, and whether such payments can be assimilated without undermining efficiency and equity of health care access.ududMethods:-udIn our review we analyse the drivers of increased cancer care utilisation, the current policies designed to control rising costs, and the potential impact of introducing patient user charges. The article also explores whether our understanding of behavioural economics could be used to create “nudge” policies that drive rational health care consumption.udFindings:-udThe costs of cancer care in the U.K. are increasing at an unprecedented rate, driven by demographic changes, innovation (radiotherapy, drugs and imaging) and consumerism within health care. Budgets are tightly constrained and health technology assessments designed to ensure coverage of high value interventions have come under significant public and political scrutiny. User charges potentially provide a framework to “nudge” patients from low value care of limited effectiveness towards high value cost effective treatment, thereby increasing overall efficiency. However supply side controls are equally relevant with greater focus on physician test ordering, and improving the quality of doctor–patient communication, especially when discussing treatment options towards the end of life.udConclusions:-udFiscal sustainability of health care financing remains a key public policy concern. Attempts at ensuring coverage of cost effective treatments have been continuously challenged and without new policies, sustainability trade-offs may be necessary with potential rationing of high value treatments. User charges provide a potential means of sustaining spending proportional to the projected rise in number of cancer cases, whilst embracing technological innovations which could potentially improve outcomes.
机译：背景：在高收入国家，提供高质量的公平医疗的费用超过了当前的预算。本文特别参考英国（英国）回顾了这些国家/地区中癌症治疗的可负担性。问题仍然在于，患者是否应该通过引入用户收费来为癌症治疗做出贡献，以及是否可以在不损害医疗服务的效率和公平性的情况下吸收此类支付。 ud udMethods：- ud癌症护理利用增加的驱动因素，旨在控制成本上涨的当前政策以及引入患者使用费的潜在影响。这篇文章还探讨了我们对行为经济学的理解是否可以用来创建推动合理的医疗保健消费的“轻推”政策。 ud发现：- ud由于人口变化，英国的癌症治疗成本正在以前所未有的速度增长，医疗保健领域的创新，创新（放射疗法，药物和影像）和消费主义。预算受到严格限制，旨在确保高价值干预措施覆盖面的医疗技术评估受到了公众和政治的严格审查。用户收费可能会提供一个框架，使患者从效率有限的低价值护理转向高价值的成本有效治疗，从而提高整体效率。但是，供应方控制同样重要，更侧重于医生的测试订购，并改善了医患沟通的质量，尤其是在讨论生命周期即将结束时的治疗选择时。公共政策关注。确保具有成本效益的治疗方法的尝试一直受到挑战，并且在没有新政策的情况下，可能需要权衡高价值治疗方法的可持续性。用户收费提供了一种潜在的方式来维持与预计的癌症病例数成正比的支出，同时支持可以潜在改善结果的技术创新。

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