The equity test 3.18 Charges are inequitable in two important respects. First, new charges increase the proportion of funding from the unhealthy, old and poor compared with the healthy, young and wealthy. In particular, high charges risk worsening access to healthcare by the poor. 7 3.19 Second, exempting low income families from user charges can create inequities for those just above the threshold. High user charges with exemptions can create disincentives to earning and working through the imposition of high marginal tax rates.
Some European countries do make more use of user charges than Britain.
They are able to do so in large part because they tend to compensate people indirectly through the social security benefit system. Even so, in Sweden, there is evidence that user charges for visiting primary care doctors have discouraged people from seeking treatment 10 . There are those who advocate maintaining the current role of public funding but shifting wholesale to a social insurance-based model. This is similar to both the German and French healthcare systems. The proponents of this model argue that it leads to larger shares of national income going to healthcare.