The Health Bill could usher in a US-style healthcare financing model, and the erosion of entitlements to free care, a paper published by the British Medical Journal warns today.

The analysis, Legal basis for providing fewer health services to fewer people in Health and Social Care Bill, tackles the key legal reforms in the bill, which is currently in the House of Lords.

Professor Allyson Pollock and David Price, both from Queen Mary, University of London, conclude that the legislation provides a legal basis for imposing new charges, and for providing fewer health services to fewer people in England.

The study says: “Taken together, the measures would facilitate the transition from tax-financed health care to the mixed financing model of the USA.”

The authors say the bill’s transfer of powers from the secretary of state to clinical commissioning groups would abolish the current duty on primary care trusts to secure health services for everyone living in a defined geographical area.

As a result CCGs would be able to provide fewer taxpayer-funded health services. CCGs will also have the power to decide what services are “appropriate as part of the health service” and to delegate the decision to commercial companies.

The paper argues: “Where a CCG or its commercial company decides that services are no longer appropriate as part of the government-funded health service they may fall out of the health service altogether and be charged for.”

Under the bill, public health functions, such as vaccination, screening services and promotion of healthy lifestyles, would also be delegated to local authorities and may be chargeable.

The authors say ministers have failed to explain which services must be provided free at the point of use and which may become chargeable.

“Legal analysis shows that the bill would allow reductions in government-funded health services as a consequence of decisions made independently of the secretary of state by a range of bodies,” they conclude. “The bill also fails to make clear who is ultimately responsible for people’s health services and it creates new powers for charging.”

They add: “The reform signals the basis for a shift from a mainly tax-financed health service to one in which patients may have to pay for services currently free at point of delivery.

“The government has been unable to show, as it has argued, that these changes are ‘vital’. It does not have a mandate for this radical alteration of health care financing and it has avoided informed debate of the principle.”