General election 2019: Labour's?500m NHS claim fact-checked" width="976" height="549">
Labour leader Jeremy Corbyn has claimed a Conservative trade deal with the US after Brexit could cost the NHS up to US trade negotiators have set out their objectives for any trade deal with the UK, including "full market access" for US pharmaceuticals - although the government says the NHS "will not be on the table".
Where does the ?500m figure come from?
We asked Labour, who directed us to an interview with World Health Organization adviser Dr Andrew Hill on a recent Channel 4 Dispatches programme. Dr Hill, from the University of Liverpool, told the BBC that the ?500m a week figure, which comes from a report he co-wrote with academics at Harvard University, was designed to illustrate how much more the US currently pays for drugs than the UK.
"It's a guide to how much money could be involved but it's difficult to predict how much money would be involved," he said. To give an idea of the "worst case scenario", he said, the report's authors compared how much was spent on medicines per person in the US and the UK. The report said this was a way to "crudely estimate" how much it would cost the NHS if it spent exactly the same as the US on drugs per head of population:
The NHS in England spent an estimated ?18bn on medicines in 2017-18
The US spent 2.5 times as much per head, according to the Organisation for Economic Co-operation and Development (OECD)
Multiplying ?18bn by 2.5 gives an annual cost of ?45bn
That's an extra ?27bn a year or about ?519m a week
In practice it's highly unlikely that NHS spending on medicines per person would end up being the same as the US's.The Labour leader was asked about the ?500m figure at his speech on Tuesday and said: "I believe it to be an accurate and credible figure... and I'm very happy for anybody else to analyse it and tell me if I've understated the case."
What is the current situation?
At the moment, of all the medicine imported by the NHS, 9% comes from the US. In contrast, 79% of medicine imports are from the European Union.
Could the NHS be "up for sale" to US companies?
Could US companies run NHS services after Brexit?
Because of the NHS's size and purchasing power, it has a lot of clout when it comes to negotiating prices. The National Institute for Health and Care Excellence (NICE) assesses the benefits of a particular drug and decides the acceptable cost for this benefit. Then the NHS negotiates with companies to lower their prices, rather than paying the market price. NHS prices are also used by several countries as a reference point, meaning those countries will not pay more for drugs than the UK does. Why do the US pay so much for prescription drugs?
What does the US want?
The US view is this is unfair to Americans, who pay more, and "significantly undervalues" medicines that are costly to develop and make. US trade negotiators have said that as part of a deal with the UK after Brexit, they want "non-discriminatory" access to the UK market.As an example, in a free trade agreement with South Korea the US stipulated that prices for pharmaceutical products should be "based on competitive market-derived prices".
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