Saturday, January 13, 2007


In the Times today there is an interview with Sir Michael Rawlins that is well worth reading.

Sir Michael is the Chairman of NICE. Although NICE was established to advise the British Health Ministry on what it should and what it should not pay for, it is hugely influential wordwide. Last November, for example, there wer 9 million hits on their website.

Rawlins has interesting things to say about the comparison between the UK and US health services, but reckons that rationing is going to come to everybody. Much culd be done to limit health expenditure. For example, Omeprazole is a useful treatment for heartburn. Manufacturer's instructions suggest that the dose should be halved after the first month. It seldom is. Yet if it were it would save the British health service $80 million a year.

The biggest difficulty comes with the conflict between the patient in front of you and teh one in the waiting room next week.

If you spend a lot of money on a small number of people, you will end up depriving many other people of cost effective healthcare. And so that's why it's impossible, really, to leave it up to individual doctors to make these decisions, it's just too difficult, and I wouldn’t want to do it in that sense. It's much better to have an organization like NICE that does it in as fair a way, and in a way that reflects the aspirations of the society in which we live.

The cost of an extra year of good quality life is set at $60,000. If your new treatment can deliver that then the NHS will pay for it. If it comes to more then you could always find the money yourself.

...if one member of my family, my children or grandchildren, were unwell, yeah, I would do everything I can." But he said, "that's me and my grandchild, I can't expect society, necessarily, to do that, too." So, with finite resources, we have to use them in the best way that's equitable.

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