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Taxing ill health
  1. David Phizackerley
  1. DTB, BMJ Journals, London, UK
  1. Correspondence to David Phizackerley, DTB, BMJ Journals, London, UK; dphizackerley{at}

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Determining whether government income is classified as a tax or a fee is complex and technical.1 Taxes are compulsory and unrequited charges, while fees are requited and should be in proportion to the cost of providing the service. It is unclear whether the NHS prescription charge in England, which is compulsory for many people, is proportionate to the cost of the service provided and should be classified as a tax or a fee. Irrespective of the technical classification, for many people with long-term illnesses who have to pay for their prescriptions it will not only feel like a tax, but also one that is penalising them unfairly for having a problem with their health.

The prescription charge has been levied in England almost continually for more than 71 …

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  • Competing interests None declared. Refer to the online supplementary files to view the ICMJE form(s).

  • Provenance and peer review Commissioned; externally peer reviewed.