How do we ration?


Category : Medical Rants

Apparently, the NHS (Great Britain) is considering their priorities. Doctors admit: NHS treatments must be rationed

It is about the money.

British doctors will take the historic step of admitting for the first time that many health treatments will be rationed in the future because the NHS cannot cope with spiralling demand from patients.

In a major report that will embarrass the government, the British Medical Association will say fertility treatment, plastic surgery and operations for varicose veins and minor childhood ailments, such as glue ear, are among a long list of procedures in jeopardy.

James Johnson, the BMA chairman, will warn that patients face a bleak future because they will increasingly be denied treatments. He will urge the NHS to be much more explicit about what it can realistically afford to do and ask political leaders to engage in an open, honest debate about rationing.

The BMA proposes the drawing up of a new patients’ charter specifying those health services to which every citizen across England should be entitled, regardless of the local health authority’s financial situation. They also want to see a second list of all the treatments which the sick will get only if their primary care trust has the money, and if doctors decide they are clinically worthwhile.

Senior BMA sources say their report recognises the reality that despite record investment in the NHS, ‘postcode lotteries’ are rife. Primary care trusts, the local NHS organisations that commission and pay for care from hospitals on behalf of patients, are increasingly rejecting requests to pay for procedures or drugs because they are not perceived to be the best use of funds.

Some PCTs have been bitterly criticised for refusing to pay for expensive new cancer drugs; treatment to prevent older people going blind through age-related eye degeneration and operations to help obese patients lose weight through stomach-stapling.

This is not a simple issue. I am not criticizing the NHS. Great Britain has made a choice about health care funding. Given limited resources, this becomes the only solution.

As a society, we must always ask how we want to invest our resources. Do we want to spend an ever increasing portion of the GNP on health care?

Our financial problems are not waste. Rather we can do more, but always at a cost. Our health care options are improving, but they do cost money.

I hope that we can do careful studies to prioritize spending should we face this problem in the US. I suspect, rather, that the decisions will depend on political considerations.

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Comments (1)

We already “ration” care in the U.S., though I have to admit that I despise this loaded term. Basically, this happens all the time in the free market allocation of resources. In the U.S., we “ration” indirectly by limiting access to any healthcare at all (via cost) for a large chunk of people while everyone else can access what they can afford or their insurance will pay for – coverage decisions made by the private sector but which are basically the same as those that the U.K. will supposedly have to make.

In the example discussed above, the U.K. is restricting access to specific treatments – not specific individuals or groups. This is just the basic nature of resource allocation when resources are not unlimited (i.e. reality). The only difference is the structure of the decision-making: hierarchical/centralized v. individual/decentralized/market-based.

One alternative to this dire inevitability – obvious yet strangely not addressed – would be to use the resources available in a more efficient manner. We do not need to spend a dime more on health care. We need value for what we do spend. For example: 2 trillion smackers is enough to keep the U.S. AND the U.K. in good health if we did not allocate it in such a way that seems only to ensure healthy profits.

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