Ministers should consider extending prescription charges, as well as introducing new charges on visits to NHS GP surgeries and some elements of hospital care, to raise £3 billion a year for the health service, a think-tank has said.
In a report, Reform noted that many other countries charge for elements of healthcare which are free at the point of use in England. New charges on a greater range of prescriptions could raise £1.4 billion, charges for GP visits £1.2 billion and hospital care charges £200 million, said the report.
The think-tank recommended that any reform should include exemptions for people on low incomes - but not necessarily for all pensioners.
A French-style system, under which only 20% of drugs are dispensed free of charge and many pensioners are expected to pay, could raise £1.4 billion a year while allowing a cut in the prescription charge from £7.85 to £3, said Reform.
Some 90% of all prescriptions on the NHS in England are dispensed free of charge, including 60% of all drugs which go free to those over the age of 60, said the report.
Limiting exemptions to those of retirement age, or removing the exemption for elderly people altogether, would be "fairer to young people as well as yielding significant extra income", said Reform.
The think-tank noted that 22 out of 31 developed countries charge for GP services, with fees ranging from one euro (84p) in France to 20 euros (£16.74) in Sweden. Some 16 of the countries charge for elements of hospital care, for example a small fee towards the "hotel costs" of an overnight stay. Italy and Ireland charge for some attendances at accident and emergency departments.
The think-tank recommended that policy-makers consider these ideas after a reform of prescription charges.
Thomas Cawston, research director at Reform, said: "Few will want to debate higher NHS charges but the funding outlook for the service makes it unavoidable. Prescription charges are the easiest route to new revenue, with exemptions for people on low incomes built in."
A Department of Health spokesman said: "We have been absolutely clear that the NHS should be free at the point of use, with access based on need.
"That is why we have increased health spending in real terms alongside £20 billion of efficiency savings to make sure the NHS continues to provide excellent care."