Paying for our services

Professor Allyson Pollock often highlights important issues that merit public debate, but her Comment piece on co-payment (Co-payment is a menace already threatening our public services, February 11) borders on scaremongering. It also suggests a mistrust of all things American in the field of healthcare - a common tack of opponents of any change.



For governments, user charges have two roles. First, they may increase resources, provided that the cost of the collection mechanism does not outweigh income. Second, they limit inappropriate demand for healthcare, such as a visit to a GP when a 30-second conversation with a pharmacist or call to NHS Direct would suffice, freeing up resources for others. However, the unavoidable problem is that research clearly shows charges also limit appropriate demand - that is essential care for the most vulnerable.

Delaying such necessary care can lead to higher overall expenditure. So governments must design co-payment systems that do not discriminate against the sick, old and poor - the French recently introduced a system that exempts the least well-off from paying at point of use.
Benedict Irvine
Civitas



Democratic control of basic services such as health is being systematically flogged off in both the developing world and the UK. As Naomi Klein argues (Democracy and Robbery, February 10), even if the people of Iraq win control of their own democratic transition, they may still find the WTO and other global institutions will make sure there is "precious left to vote for", with rich countries pushing free trade and the general agreement on trade in services.



Gats results in basic services being privatised and run by multinational companies based in a different continent. The citizens of Yorkshire were bemused to find their water supply owned by a US firm; imagine how it feels for the poorest in Angola or Bangladesh or the Philippines, where a voice in basic services is vital to survival.
Graham Bennett
One World Action



Professor Pollock refers to the "high costs" of PFI contracts, which "have seen a reduction in services". In fact, PFI has allowed the government to launch its biggest ever public-service refurbishment programme - 70 hospitals and 500 schools so far, completed on time and on budget. That's thousands of children and adults benefiting from state-of-the-art facilities rather than struggling to teach, learn or heal in crumbling buildings. PFI is delivering.
Lindsay Grist
Director, PPP Forum