EXTRA money for the NHS "will have to come from new, or higher, taxes", researchers have said.

Setting a new tax rate designed to raise enough to cover the expected demand for healthcare or earmarking taxes on tobacco, alcohol and sugary drinks to raise funds specifically for the NHS are among the options put forward in a paper today.

It comes as the NHS approaches its 70th birthday on July 5.

Read more: Scots support tax hikes to improve the NHS 

In an analysis published in the British Medical Journal (BMJ), Dr Mark Hellowell of Edinburgh University's Global Health Policy Unit along with colleagues from the Nuffield Trust think tank and Oxford University warn that the NHS is "finding it increasingly difficult to maintain performance on several high profile targets".

It follows eight years of historically low funding growth from 2009/10 onwards which the authors say has lead to a "growing sense that things might have to change".

Over the past 70 years, NHS spending has grown ten-fold in real terms but the UK still remains a relatively low healthcare spender compared to other developed nations including Canada, Germany, Australia, Japan, Sweden, Denmark, France, the Netherlands, Switzerland and the United States.

Read more: Think tank IFS says extra taxes worth up to £2000 per household needed for NHS

The UK employs fewer nurses and doctors for its population size compared to the EU average, and also has a lower number of hospital beds, MRI machines, CT scanners per head than its neighbours.

Dr Hellowell and his co-authors stressed that the ten-fold increase in funding since 1948 has been largely financed by "much reduced" spending on defence, housing and nationalised industries but there was now "much less room for this sort of reallocation".

They add: "Other areas of public service -including housing, welfare and education, which are important determinants of health - have already been cut to the bone; extra money will inevitably have to come from new, or higher, taxes."

On current income tax rates, the top 10 per cent of earners across the UK contributed 59 per cent of revenue to the Treasury in 2015/16.

Funding for the NHS in Scotland is largely determined by the tax and spending policies set at Westminster, with Holyrood's funding allocation determined via the Barnett formula.

As a result, if public spending on health increases in England, a corresponding increase in funds is sent to Scotland, although it is up to the Scottish Government how to spend it.

Read more: Former Scottish health minister proposes 'health tax' for NHS 

Therefore extra, or higher, taxes designed to raise additional funds for the NHS in England would lead to an equivalent increase in cash available to spend on public services north of the Border too.

Although introducing charges is sometimes suggested as a way raise money while reducing "'frivolous' or unnecessary demand", with some backing dentist-style fees to see a GP or fines for patients who fail to turn up to an appointment, Dr Hellowell and his co-authors said these "can only play a modest role in raising money otherwise they raise the goal of equity of access".

They pointed to the RAND health insurance experiments in the US in the 1980s which "found that charging deters legitimate use, particularly among the poorest, eldest and sickest patients".

The Herald:

(Purple line=UK NHS spend as % of GDP from 1950/51-2020/21; Yellow=UK NHS real terms spending, £bn)

A new ring-fenced NHS tax, which surveys suggest would be supported by the majority of voters, would "bring the UK into line with its European neighbours", where healthcare is often funded through compulsory social health insurance premiums levied on wages and employers, in addition to general taxation, subsidies and direct payments.

Rather than a model of ring-fencing where the amount of money spent on a service is determined by the amount raised - which is unpredictable - the authors said Government could "set an NHS budget based on independent forecasts of demand and set a tax rate that is expected to raise enough to cover the cost".

They added: "If it turns out to raise more, or less, then the Treasury keeps the surplus or pays the extra from borrowing or general taxation".

An argument could also be made for earmarked taxes on "health damaging products" such as tobacco, alcohol or sugar-sweetened drinks.

They state: "In these cases, taxes help address the behavioural causes of ill health and reduce healthcare demand, as well as raising money.

"And while the tax burden may be regressive, the distribution of benefits in terms of improvements to health is skewed towards those on lower incomes."