Transcript Rationing Health Care

• Healthcare rationing is used by health insurers, the
government and individuals to save money.
• Most of us believe that if there is a treatment
available, no matter what it costs, and no matter what
chance there is for a positive outcome, it should be
made available to us. We get frustrated when we are
told we can’t have it or we’ll have to pay extra for it.
• However, since funds are limited, then our options are
limited, too, in a variety of ways.
• A survey of almost 3,000 doctors by Doctor
and Hospital Doctor newspapers found that
one in five doctors know patients who have
suffered harm as a result of rationing.
• More than 5% of GPs surveyed also said they
knew of patients who had died as a result of
being denied treatment on the NHS. (2009)
• Waiting lists, clinical decisions, approved drug lists
and spending priorities are all mechanisms to manage
limited resources.
• Choices have always been made about which patients
should receive treatment and which should not.
• Many people feel uneasy with the process of
rationing due to the fact that decisions are being taken
on an ad hoc basis by individual Primary Care Trusts
(PCTs) in England, Wales and Health Boards in
Scotland.
• Critics have pointed out that if the health
service is to remain a national one, it is
unacceptable that treatments are available in
one area but not in the next.
• A recent example of this ‘post code lottery’ is
the use of the drug herceptin in tackling the
early stages of breast cancer. While some PCTs
were prescribing the drug, others were refusing
to prescribe it due to cost. (2006)
• In the UK health authorities take guidance from the National
Institute for Health and Clinical Excellence (NICE) in England
and Wales and the Scottish Medicines Consortium (SCM) in
Scotland.
• These bodies decide if new drugs are cost effective and if they
should be offered to NHS patients or not.
• A recent example of this is, in 2006, the SMC decided not to
recommend Temozolomide (a brain tumour therapy treatment)
as it declared the drug did not represent value for money. This
decision was taken despite 36 of Britain’s leading cancer
specialists writing to Patricia Hewitt, the Health Secretary at
Westminster asking that the drug be freely available on
prescription.
• East Suffolk NHS Trust was heavily criticised
for proposing that obese people should not
receive hip and knee replacements.
• The ban would apply to people with a Body
Mass Index (BMI) of 30.
(This would be, for example, a woman who is
1.58 meters tall and weighs 75 kilos, or a man
who is 1.78 meters tall and ways 93.8 kilos)