Economic pressures

Economic burden can be considered in a number of different ways. Firstly, there is a burden to the health service in terms of the amount that it costs to provide the direct care to patients. 1994 figures suggested that the costs were around 2% of the total NHS budget (Williams, 1997). New drugs (particularly the biologics) and increased levels of skin cancer are likely to mean that this figure has increased; however, they may have been offset by decre ases in the amount of care provided on an in-patient basis. Secondly, there is an economic burden to society as a whole, as people with skin disease have to take time off work and are therefore unproductive. Williams sites that skin disease was one of the most common reasons for claiming injury and disablement benefit in the period 1977–1983. Finally, the personal economic burden has not been evaluated in terms of cost. However, a US study found that around 10% of people believed that their skin condition was a handicap to them while working or doing housework (Johnson & Jones, 1985). The economic impact of eczema is discussed in Eczema.

For some, the social stigma felt because of their skin disease prevents them from applying for jobs, and anecdotal reports from patients make it clear that it can be difficult to get jobs that involve face-to-face contact with members of the public. Whilst potential employers should not discriminate against employees because of their skin disease, there are still some instances where employment may be prevented because of the condition. For example, the British Armed Forces list chronic eczema, severe psoriasis and severe acne as conditions that would make a person permanently unsuitable for entry into the services. There is also a very real direct cost to patients with skin disease in terms of what they need to do to manage their condition. Thus, unless the individual is eligible for free prescriptions, costs of these can be very high especially as often 2, 3 or even more items are required. It is sometimes cheaper for individuals to buy a season ticket, where they pay a lump sum up front and then receive free prescriptions regardless of the number they need. In England, details can be found at www. nhsbsa.nhs.uk/1127.aspx and in Scotland at www.psd.scot.nhs.uk/doctors/prepaymentcertificates. html. However, the costs do not stop at prescriptions. Table 6.1 shows some of the other additional costs that someone with skin disease may incur.

Table 6.1 Possible personal costs of a skin disease.   Modification Personal costs   Environmental modifications particularly for patients with eczema Changing curtains for blinds Changing carpets for hard flooring Cotton clothing/special clothing Water softener Extra cleaning Special mattress and bedding covers   Extra washing of clothes and bedding due to greasy treatments Increased water usage Increased energy usage (electricity) Increased washing detergent Need to replace washing machine more frequently   Attempts to find ‘magic cure’ Money and emotion wasted on unproven and potentially dangerous treatments