In a letter published in The Lancet, in response to their recent series on universal health coverage, John Lee and colleagues from the Department of Primary Care & Public Health at Imperial College London comment that many people still need to pay a high proportion of total health expenditure out of pocket. Patients’ costs must be reduced to further improve health and provide financial protection in health systems with universal health coverage Governments should continue to lower user charges in health systems with universal health coverage Rather than seeing lower financial contributions from patients as an efficiency loss, they should see it as a means to promote prevention and the use of cost-effective services.
NHS budgets are under considerable pressure. It is therefore unsurprising that many NHS Integrated Care Boards (ICBs) In England will aim to prioritise price in contract awards, But this approach is a significant threat to community-centred healthcare. While competitive tendering is a legally required, an excessive focus on costs in awarding NHS contracts risks overshadowing key factors such as established community trust, local expertise, and the long-term impact on continuity of care. This shift towards cheaper, often external, commercial providers threatens to cut the links between communities and their local health services. The argument that competitive tendering is solely about legal compliance, and not cost, is undermined by the very nature of such tendering, which by design encourages the lowest bid. This approach risks eroding the social fabric of local healthcare provision, where established relationships and understanding of specific community needs are essential. Establishe...
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