NEARLY four in ten pensioners in Scotland say they would be willing to pay for some non-life threatening treatments, such as cataract and haemorrhoid removal, if the money saved was spent on social care.

A poll by the BMG for the Herald found that 39 per cent of over-65s would back such a move in order to cut costs for the NHS as long as the savings were ring-fenced and used to fund social care.

However, half of of those questioned said they opposed any shift to direct payment, while 12 per cent said they did not know.

The survey was based on a sample of 561 people aged over-65, with SNP voters most likely to oppose payment (61 per cent) while Conservative and LibDem voters were most sympathetic to the idea (51 and 47 per cent respectively).

The model is the norm in other western countries, such as New Zealand, where elective procedures are "scored" in order to decide whether they should be publicly-funded or not, in a form of healthcare rationing. Patients with excluded ailments such as hernias or haemorrhoids can decide whether to go private or pay for the treatment with health insurance.

As our population ages, the key debate rests on how to fund health and social care services as demand increases.

The UK spends 8.5 per cent of its GDP on health and 15 per cent on social care, far short of comparable European countries. Both France and Sweden spend 11 per cent of their GDP on health and 21 per cent on social care.

Even when the comparison is restricted to public sector spending rather total healthcare spending, such as patients paying for private treatment, the UK was spending $2,802 per head in 2013 compared to $4,197 in the US, according to research by the London School of Economics.

However, high spending alone does not necessarily translate into the best outcomes. An acclaimed study, 'The American Healthcare Paradox', noted that despite the US spending 16 per cent of its GDP on healthcare - more than Australia, New Zealand, Canada or any European nation - its health outcomes were generally poorer. The authors concluded that while the US invested in acute hospital care, rehabilitative care, diagnostic imaging, laboratory tests and health insurance, it was being let down by comparatively low GDP spends on education, old age pensions, disability and sickness benefits, unemployment benefits and housing support.

Dr Elizabeth H. Bradley, director of Yale University’s Global Health Leadership Institute, said: "Our study found that countries with high health care spending relative to social spending had lower life expectancy and higher infant mortality than countries that favoured social spending."

The NHS is also hamstrung by a healthcare inflation rate that runs at around 2.5 to three times that of average inflation. The largest costs for most NHS boards, and trusts in England, are staffing, drugs and repaying PFI contracts, in that order.

While there is no consensus from think tanks, health economists, and medical professionals on which healthcare funding model is best, there is consensus that unless we start spending more - or choose to do less.