Public Acceptability of Health and Social Care Funding Options

Funding Options for the NHS and Social Care in the UK

Published in: The Health Foundation (February 2019)

Posted on RAND.org on February 20, 2019

by Jon Sussex, Peter Burge, Hui Lu, Josephine Exley, Suzanne King

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The demand for health and social care in the UK is growing, as a result of an ageing population and the increasing range of health care made possible by medical advances. Considerable additional funding will be needed in future. In this paper we report research providing new evidence about the preferences of the general public with regard to the various ways of raising the additional funds that NHS and social care in the UK will require, ranging from taxation to mandatory insurance, to voluntary insurance, to user charges.

We conducted focus groups with members of the public in all four UK countries and used the findings to design a discrete choice experiment (DCE). In the DCE, with a total of 2,756 respondents, we tested people's preferences between different ways of funding health care and social care by asking them to make a series of choices between pairs of options. The DCE results show that:

  • Public knowledge of the scale of NHS and social care funding is poor and few people realise the large extent of private funding of social care.
  • All sections of the public—across age groups, income groups, employment status, health status and countries of the UK—would like additional funding for social care to be raised in the same way as additional NHS funding.
  • Across all sections of the population, people prefer a collective rather than individualistic approach to raising additional funds for both health care and social care.
  • There is a preference for the percentage of income paid to be higher for people on higher incomes, that is for a progressive system. Those in higher income groups supported this too, albeit not quite as strongly as people on lower incomes.
  • All age groups prefer that contributions should not differ by age. Older age groups had a stronger preference for this non-discrimination, but even the 18–24 age group did not, on average, want over-40s to pay more.
  • There is a strong preference that raising additional funds for both health care and social care should be by a public body rather than a private company.
  • There is support for some form of earmarking of the funds raised so that they can only be used for health care or social care.
  • The public's preferences are very similar across England, Northern Ireland, Scotland and Wales, once age and socioeconomic characteristics are controlled for.

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