Funding Options for the NHS and Social Care in the UK
Research on the public acceptability of different health and social care funding models first examined other countries' funding schemes and found there is no single, commonly preferred solution to achieving sustainable revenues. The second stage of this research assessed the popularity of different funding approaches among the UK public.
Health and social care services in the UK are facing a significant delivery challenge as the pressures on the service far exceed planned funding. The task facing the government is not just to secure the resources and deliver service change for the short term, but also to place health and social care services on a more sustainable footing for the longer term. To do this a public and political consensus on the longer-term funding levels and how to raise the money also needs to be established.
RAND Europe was commissioned by the Health Foundation to identify a range of feasible options for the future funding of health and social care in the UK and their relative acceptability. The first stage of this research examined how other countries fund health and social care. The second stage then assessed how popular different funding approaches are among the general public.
RAND Europe led the research in collaboration with the Personal Social Services Research Unit at the University of Kent and the European Observatory on Health Systems and Policies.
The approach included assessing international evidence and thinking about how to fund care, comparing that with current funding arrangements in the UK, and testing the relative public acceptability of different funding options in a choice experiment, before final reporting.
Taxation and other public sources primarily fund health care in most countries reviewed. Social care, however, relies to a much greater extent than health care on private funding from individuals.
There is no single, commonly preferred solution to achieving sustainable revenues. High-income countries have taken diverse approaches to tackling the need to increase health and social care funding.
Funding reforms are more commonly driven by changes in economic conditions rather than by rising demand for care. These reforms tend to be incremental, not radical, and are constrained by the history of how funds have been raised hitherto.
Discrete choice experiment across the four UK countries
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 on average 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 on average 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, i.e. for a progressive system. Those in higher income groups supported this too on average, albeit not quite as strongly as people on lower incomes.
All age groups on average 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 than younger people.
There is a strong preference on average 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.