A report commissioned by private health insurer BUPA claims the NHS should brace itself for a projected £11bn funding gap and subsequent return to 1997 levels of performance by 2015 if high levels of investment do not continue.

A report commissioned by private health insurer BUPA claims the NHS should brace itself for a projected£11bn funding gap and subsequent return to 1997 levels of performance by 2015 if high levels of investment do not continue.

If the government cannot find the money to fill the gap by taxation or other means, the report recommends a range of solutions including the introduction of 'co-payments' whereby patients would pay for non-clinical services such as hospital 'hotel fees' covering bed and board and ancillary services.

The report says a system of relatively small payments for high-volume services, bounded by exemptions and subsidies, 'would raise significant income'. It also recommends that a wider cross section of people pay for private medical insurance, which it says would free up NHS resources and funds to treat other patients.

A third option suggests NHS patients could top up their NHS 'entitlements' to access additional services and different care settings. This approach, the report says, 'would allow individuals who wished to, to access additional services at a relatively affordable cost'.

'It also provides scope for the NHS to be more explicit about what it will and will not fund, and allows individuals to access care that is not regarded as core to the NHS.'

It adds that such an approach reflects the Commons health select committee's recommendations that the NHS should explore the feasibility of establishing an NHS core package of care available to everyone, with charges for services that do not merit NHS funding. These 'additionals', which might include treatments rejected by the NHS on cost grounds, might be paid for out of insurance or direct payment.

Other suggestions include increasing the level of public funding through tax increases or by redistributing public expenditure to allow the government to continue to spend proportionately more on health than other public services. It also proposes that the NHS increase its productivity, but warns that 'the track record so far has been poor'.

BUPA commissioned economic consultancy NERA to produce a computer model of the English NHS that simulates its behaviour and projects to 2015 the likely activity levels and resources.