News / Health Foundation calls for review of emergency marginal rate

The Health Foundation has called for fairer
reimbursement of emergency care, after it found trusts have been losing elective income as they prioritise non-elective services to meet rising demand.

In a report on the financial position of providers, A year of plenty?, the foundation urged NHS Improvement and NHS England to review the marginal rate for emergency care and whether there should be a similar system for elective activity.

The foundation said the increased NHS provider focus on emergency work has meant more and more elective care has gone to non-NHS providers. 

However, while elective activity is paid at full tariff, a proportion of emergency care is paid at a marginal rate. This is currently set at 70% of the standard tariff for activity above a baseline monetary value.

Anita Charlesworth, the Health Foundation’s director of research and economics, said: ‘Rising demand for emergency care meant NHS providers haven’t had the capacity to deliver planned care and patients had to be diverted outside the NHS. NHS hospitals were left squeezed by sharply rising drug and staff costs with little additional funding. 

‘The NHS urgently needs to look at how to ensure additional funds reach NHS providers,’ said Ms Charlesworth. ‘The health service needs to plan better for emergency demand, fund emergency care fairly and make sure it gets the best possible price for care provided outside the NHS.’