Prescription Charges Can Damage Your Health, Says CAB Report

Prescription charges are preventing many poorer people with chronic health problems getting the treatment they need, a new report from the National Association of Citizens Advice Bureaux (NACAB) says today.

In Unhealthy charges, CABx report that many people are putting their health at risk because they cannot afford to pay for essential medicines. A study conducted by MORI for NACAB reveals that around 750,000 people in England and Wales fail to get their prescriptions dispensed because of the cost.

A separate NACAB survey of 1,029 CAB clients who had paid prescription charges within the last 12 months found that 28 per cent had failed to cash all or part of a prescription because of the cost. Half said they had had difficulty affording payment. Twenty per cent of those who had problems paying were on incapacity benefit or other disability or sickness benefits.

People with long term health problems were particularly hard hit, with 37 per cent failing to get all or part of their prescriptions dispensed. People with asthma, for example, were imposing self-rationing on their medication to save on prescription costs, while people with mental health problems were being forced to choose between living below the poverty line or not having medication essential to their ability to cope in the community. Some bureaux have had to seek cash help from other charities to enable clients to cash the prescriptions they need.

Cases reported by CABx include the following:

A single mother suffering from glaucoma who is registered blind. She has no sight in one eye and very limited sight in the other. She has been told she will lose what little sight she has unless she uses the prescribed drops, but she cannot afford the eight items prescribed each month, and she cannot afford to buy a pre-payment certificate.

A woman with multiple sclerosis who has to pay between 16330 and 16342 a month for essential medication to control her condition out of her income support and disability living allowance. She applied for free prescriptions but was turned down on the grounds that her income is 15 pence over the limit. She is suffering great financial hardship and cannot afford to have all her prescribed medication dispensed.

A woman with serious multiple health problems who was entitled to free prescriptions while she worked and claimed Disability Working Allowance, but who has had to pay since she was forced to give up work when her condition deteriorated, even though her income is much reduced.

Prescriptions now cost 1636.10 per item in England, and 80 per cent of people aged 18-60 have to pay the full cost. (The Welsh Assembly has frozen charges at 1636 and abolished charges for under 25s.) People on income support or with an equivalent income get free prescriptions. But anyone whose income exceeds income support levels - even if only by a few pence - is cut off from all help with payment. This means people whose only income is incapacity benefit - by definition likely to be heavy users of prescriptions - are excluded from help, even though their income is little higher than income support.

The only help with budgeting for the costs of prescription charges is the pre-payment certificate, or 'season ticket', allowing unlimited prescriptions at a cost of 16387.60 for 12 months or 16331.90 for four months. But many people on very low incomes cannot afford to pay the lump sum required up front.

NACAB argues there is a strong case for abolishing prescription charges altogether. Failing this, it urges the government to reform the prescription scheme by pricing the pre-payment certificate on a sliding scale. This would enable patients with incomes just above income support level to share the benefits of a cap on their total expenditure currently only enjoyed by people who can afford the lump sum.

NACAB Chief Executive David Harker said:

"The government has acknowledged the clear link between poverty and ill-health and has committed itself to tackling health inequalities. Added to this, the first core principle of the NHS plan is that the NHS will provide a universal service based on clinical need, not ability to pay. But the experience of CAB clients shows that prescription charges can seriously damage your health, and the impact is felt most severely by people on low incomes and with long term health problems."

He added: "It is hard to see what purpose prescription charges serve when so many people do not have to pay, but so many of those who are required to pay can literally ill afford the costs."

Technical details

1. Unhealthy charges: CAB evidence on the impact of health charges, is available from the Social Policy Department, NACAB, Myddelton House, 115-123 Pentonville Road, London N1 9LZ. (Price 1636).
2. This report is based on evidence submitted by 190 CABx in England and Wales between February 1999 and April 2001. In addition, a client survey was undertaken during one week of November 2000 to examine the extent of difficulties clients face in paying health charges.
3. A study on prescription charges was also undertaken by MORI and a nationally representative quota sample of 1,052 adults was interviewed throughout Great Britain across 150 constituency-based sampling points from 6-10 April 2001. All interviews were conducted face-to-face, in-home and the data have been weighted to the known profile of the British population. The study reveals that of those who have to pay for a prescription each time they have one dispensed, seven per cent fail to do so because of the cost, which equates to around 750,000 people in England and Wales.
4. In the year 1999/2000, the CAB Service dealt with over 90,000 health related problems; difficulties paying health charges was one of the most common concerns. CAB services in health care settings have increased significantly in recent years. Over 200 CABx now provide such services, with 76 mental health projects, 77 in-hospital services and 119 CABx providing services in GP surgeries.
5. NACAB has two linked websites: www.nacab.org.uk and www.adviceguide.org.uk
6. NACAB is an independent charity providing free, confidential and impartial advice through a network of more than 650 main bureaux and over 1,000 outreach services. There are over 28,000 people in the CAB Service, 90% of whom are volunteers. CABx in Northern Ireland are supported by the Northern Ireland Association of Citizens Advice Bureaux. CABx in Scotland belong to a separate organisation, Citizens Advice Scotland.