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People who pay taxes deserve to see that these have a sound basis. Taxes that have transparent links with the goods, services or activity they are levied for, and are applied fairly, can be tolerated. The prescription charge in England − a tax in all but name − fails these basic criteria.

To infrequent users of prescription medicines, the charge (currently £7.20) may seem reasonable. They and others may also believe that the payment relates directly to the true cost of their medicine and is specifically for funding the NHS. Therefore, they might be surprised that neither of these is true, and that the charge is treated as a way of raising general tax revenue. The prescription charge also has other, indefensible, features.

First, there are the devolutionary moves to abolish the charge in three of four UK countries. The result is that within a so-called ‘national’ health service, England alone will have a prescription charge from April 2011. This fact destroys a key argument advanced for the charge: that it helps patients to appreciate that medicines cost money and so not to abuse prescription services. Why only people in England need such a reminder is far from clear.

Supporters of the charge may argue that many people are exempt from payment. But, the categorisation of medical and other exemptions is so illogical that it is not surprising NHS Prescription Services is compiling an online quiz for professionals to test their knowledge about ‘charge status’.

One concern voiced about the possibility of free prescriptions for all in England is that it might encourage patients to demand medicines of dubious value. The counter-argument is that if there is such a weak case for using products, they should not be available for prescription in the NHS. Charging only some people for these prescriptions is a poor substitute.

The prescription charge in England is a poorly conceived, manifestly unfair tax that shames the NHS and Department of Health. It needs to go.

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