What the National Health Service (NHS) in the UK covers, and what costs patients extra

The National Health Service in the United Kingdom was set up in July 1948 to cover everyone in the country for all health care. It was set up to be free at the point of delivery, and paid for out of national general taxation.

This article is a follow-on from my previous one, The National Health Service in the UK: who pays, and who is covered, which looks at how the NHS was set up, who is eligible for treatment, and how much the whole system costs.

This hub examines what types of medical care are covered by the NHS, including doctors, hospital treatments, dentists, and opticians. It also details what patients have to pay for, such as fillings and prescriptions, how much they cost, and who gets them for free.

It also considers other associated matters, such as assistance for wigs or travel costs for NHS patients.

Different universal health systems in different countries have varying arrangements, as to whether patients pay for visiting a GP, or for hospital stays or long-term drugs.

The NHS is split into four parts, for England, Wales, Scotland, and Northern Ireland. The differences aren't great, but there are some minor variations in terms of payment for prescriptions and so forth. This article is about the rules, regulations and system in England.

Medical care - from doctors, nurses, physiotherapists, radiologists, health visitors, midwives, the whole shooting match, is free of charge at all times.

There is no contributory payment. No-one covered by the NHS pays for any visit to any doctor, nurse, health visitor, or other health care professional. There is no additional payment for X-rays, drugs given while in hospital, or any related medical care.

All medical conditions and proceedures are covered. There is no limit to the amount of health care provided to one person over any period of time.

The assessment is on clinical need, not on how much someone has been treated in the past. So treatment for a minor ear infection and a heart and lung transplant cost the patient the same - nothing.

Things such as breast reductions, plastic surgery, gender-change surgery and so forth are provided on the NHS if there is a clinical need for it. So you won't get a nose job because you don't like the shape of it, but you will get treatment for a broken nose, to put it back to normal, or a breast reduction if you are suffering strain on your back.

While in hospital, patients are fed and watered, and this is also free. Although it must be said, the quality of the food isn't that great. I ordered my other half to bring in sandwiches and snacks when I was in hospital after the birth of my son. There is only so much over-cooked pasta and soggy cabbage I can eat, and I reached the limit quite quickly.

Drugs given in a hospital or clinic are free. All contraceptive prescriptions are free. All drugs and medicines for tuberculosis, cancer treatment, and sexually-transmitted diseases are free. Drugs given at a General Practitioner's Surgery are also not charged for - so an injection for anything, administered by a doctor or nurse, is free of charge.

The only drugs which patients pay for are those issued for out-patients by a GP. The cost is £7.20 (about $10.80). The charge is standard, whether the actual drug costs £2 or £200 a dose.

A lot of people are exempt from paying for prescriptions. The current NHS list of exemptions is as follows, people don't pay if they:

• are 60 years old or more;
• are 15 years old or less;
  
• are under the age of 19 and in full-time education;
• are pregnant, or have had a baby in the previous 12 months;
• have a continuing physical disability which means a person cannot go out without help from another person.

In addition, people get free prescriptions when they are on benefits when unemployed or on a low income, or their spouse or partner is on such benefits.

That means that more than half of prescriptions aren't paid for. For example, I had free prescriptions until my 19th birthday, had to pay for them from the age of 19 to 27, then had free prescriptions for nearly two years when pregnant and a new mother, and now pay for them again.

If you need a lot of prescriptions, you can buy a pre-payment certificate which costs £104 (roughly $156) a year. So the maximum any person pays for drugs per year is £104. These are useful for people with long-term chronic illnesses.

My sister, for example, suffers from Coeliac disease. She gets quite a lot of different things on prescription, including gluten-free bread, biscuits, and pasta, as well as drugs. She has a yearly certificate.

The NHS doesn't cover all dentistry for all people.

Everyone is entitled to register as a National Health Service patient with an NHS dentist. There are a set list of charges to be paid as an NHS patient.

Some people get all NHS dentistry free, if they are:

• are 15 years old or less;
  
• are under the age of 19 and in full-time education;
• are pregnant, or have had a baby in the previous 12 months;
• are on benefits for unemployment or on a low income, or their spouse or partner is on such benefits;
• an in-patient in hospital, including a dental hospital.

If you don't get free dentistry, there are set charges for NHS patients. There are 3 sets of charges:

Band 1 - covers an examination, X-rays, scale and polish, fissure sealing, and fluoride varnish;

Band 2 - covers Band 1 plus any fillings, root canal treatment, or extractions;

Band 3 - covers Band 2, plus crowns, bridges, and dentures.

You only pay a Band Charge once for one set of treatment. So if, for example, you visit your dentist for a check-up and hygienist appointment, go back a week later for a filling on one side of your mouth, and back the following week for a filling on the other side, that is one Band 2 treatment. You are also covered for additional treatment within the next couple of months, and for repairing work done for up to 12 months, by the same payment.

As a general rule, orthodontic treatment is free for under 18s, and not for adults. There are some exceptions for adults with particular problems.

At the moment, Band 1 is £16.50 ($24.50), Band 2 is £45.60 ($68), and Band 3 is £198 ($297).

All the above is how it is supposed to work, but in my opinion, the dentistry side of the NHS works less well than the medical side.

Firstly, it's often quite difficult to get taken on as an NHS patient with a dentist, whereas there is never any such difficulty with medical care or finding a GP. Appointment times aren't all they might be, either.

Secondly, treatment is all about "clinical need" not cosmetics. So you can only get metal braces on the NHS, for example, not more subtle white ones.

I've never been an NHS patient for dentistry, but have had private treatment since birth. It seems more hassle than it's worth, as far as I'm concerned. I pay £60 ($90) every 6 months for a check-up and polish as a private patient. I've never needed any fillings or similar, so that's not an issue for me.

People get free eye tests when needed (every 6 months to 2 years, depending on whether the person is healthy etc) if they meet the following conditions:

• are 60 years old or more;
• are 15 years old or less;
  
• are under the age of 19 and in full-time education;
• are blind or partially sighted;
• have glaucoma or diabetes, or are at risk of these, or have a close relative with glaucoma;
• are on benefits for unemployment or on a low income, or their spouse or partner is on such benefits.

Most of the people who are entitled to free eye tests also get vouchers towards the cost of glasses, if they are needed. The vouchers aren't generous enough to go for designer lenses, though!

The system is easy to use and very simple. You can pay for an eye test, and then claim the cost back if you are entitled to, which is the easiest way of doing it, and also apply for a voucher for glasses.

You can almost always get a same-day appointment, and the test costs about £17 ($25) (that's what my last one cost in London).

These costs are only for testing eyesight and for glasses or contact lenses. Any eye injury, infection or damage is a medical matter, and treatment is free.

For certain people,mostly those on very low incomes, etc, the NHS pays for people to travel to hospitals for appointments, pays for people to go with a patient if they can't go alone, and people can make claims for visiting close family members in hospital, too.

People who are on very low incomes, or under 18 or over 60, can also get free wigs, fabric supports, support garments and so forth if they need them as a result of medical treatment.