Fred Roeder and Bill Wirtz: Stop ‘rationing by spreadsheet’ – patients deserve more choice in access to medicines

​​Fred Roeder is Managing Director and a health economist. Bill Wirtz is a Senior Policy Analyst. Both work at the Consumer Choice Center in Washington DC.

When it comes to access to life-changing new medicines, the UK is becoming increasingly isolated and not in a good way.

Patients here face a rigid system that denies them options available in other universal health systems.

In June, NICE rejected two breakthrough Alzheimer’s drugs already approved in Britain and used abroad.

Not because they failed clinically, but because their cost per QALY, “quality-adjusted life year, exceeded NICE’s affordability threshold. That threshold, £30,000 per QALY, hasn’t changed since 1999. If simply updated for inflation, it would be over £50,000 today.

Unlike France or Germany, patients here cannot contribute towards treatment if the NHS says no. In those countries, patients can use co-insurance or top-ups. In Australia, they can make co-payments.

These mechanisms keep universality intact while giving patients more choice.

Britain, by contrast, offers an all-or-nothing deal. If NICE declines, your only option is to go fully private and lose NHS support entirely. Families are forced into impossible decisions: abandon a promising drug, or shoulder crushing costs.

Worse, NICE’s models routinely overlook long-term savings such as delayed entry into care homes, reduced carer burden, or prolonged independence. Because these benefits are hard to model, they are often ignored. But ignoring them doesn’t make them less real.

Treating illness before it escalates is both compassionate and fiscally responsible.

Ministers have promised to review value-for-money rules after Brexit.

That’s welcome.

But tweaking the numbers won’t fix a system that is structurally outdated.

The UK has shown ambition elsewhere: the MHRA’s fast-track approvals have been hailed as proof Britain can lead in innovation. Yet what’s the point of approving new treatments if NICE won’t fund them and more importantly patients aren’t allowed to co-fund access themselves?

Critics will cry foul about creating a “two-tier system”. But let’s be honest: one already exists. Wealthier patients pay privately or go abroad. Everyone else goes without. A structured, transparent co-insurance option would make the system more equitable, not less.

This is not about importing American healthcare.

It’s about following the example of successful universal systems across Europe, where public guarantees are preserved but patients are not blocked from exercising choice. Public and private elements coexist not in conflict, but in support.

Politically, reform would be popular. Families want more say in their care, especially when facing devastating illnesses. And a system that balances fairness with flexibility would strengthen, not weaken, public confidence in the NHS.

The government has an opportunity here: to back patients, support innovation, and ensure the UK remains globally competitive in life sciences. Updating NICE’s thresholds and introducing co-funding would not undermine the NHS’s founding principle, rather modernise it.

At present, our system is rigid, penny-wise, and blind to patient realities. It is time to stop rationing by spreadsheet and start treating people as individuals with agency, dignity, and the right to hope.