I wonder what an emphasis on societal efficiency would do to expensive Surgical procedures? Would you deny a surgical technique when it has a low probability of success, and only modestly better outcomes?
Posts: 7707 | Registered: Oct 2004
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At some point, yes, you deny treatment that could posisbly help people, either saving or improving their life, based on cost. You have to; it's imperative. Consider the alternative. The way healthcare costs (and the size of our nation's elderly population!) are growing, we will eventually be forced to spend 100% of GDP on healthcare if we want to provide everyone with every medical option available to them. As technology advances, we are able to keep people alive longer and longer, but only at enourmous cost. We have to draw the line somewhere. At this point, we use how much money you have to draw the line; if you can afford the absurdly expensive, low-probability treatment, you can have it, but if you can't afford the high-probability, vastly-life-improving treatment, nope, sorry, can't do that.
What I'm saying we should do is ration healthcare through utilitarian methods. We decide (through surveys of Americans) how much we're willing to spend (on average, or through some method) on one "Quality-Adjusted Life Year" and based on that, use public funds to pay for everything that meets that criteria and deny public funds the the rest, leaving it up to individuals to decide if they are willing to pay for those other treatments (or purchase insurance against the chance of them needing those treatments, etc.).
This would effect everything from medication and surgical proceedures to immunizations and early-screening programs designed to catch cancer and such. Heck, it might even effect dental care if we decide that having good teeth is worth sufficient quality of life.
Anyhow, we will be able to make the program as large or as small as we want it. Heck, we could limit nationally-funded proceedures to those which cost a net of $0 or less, meaning we only fund those proceedures which save money over the long run. Most countries, as I said earlier, generally fund stuff which costs between $40-20,000 or less, and will occasionally fund more expensive things as well.
Posts: 1710 | Registered: Jan 2004
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"I wonder what an emphasis on societal efficiency would do to expensive Surgical procedures? Would you deny a surgical technique when it has a low probability of success, and only modestly better outcomes?"
The simple answer is yes Drake. Every operation that involves anaesthetic and incision involves risks of infection, choking etc. These have to be balanced out by the benefits of the procedure.
NICE does also assess operations and has recently highlighted British hospitals as doing too many hysterectomies and tonsilectomies. Surgeons would like to do fewer but often encounter a public attitude of 'can't you take them out Doc'.
It reminds me of the circumcision debate we had a while ago. An operation with minimal benefits that the US pays for with taxpayers money. Why lopping foreskins get the public health vote when little else in US medicine does bemuses me.
Posts: 743 | Registered: Sep 2005
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