Once again, Britain shows its creativity in educating it's populace about the costs of healthcare in their system with their on-line Virtual Hospital. In it, the have patients explaining why they should have a second chance for a liver transplant after a life of alcoholism, or a patient explaining how he thinks their system let them down after he tried (and succeeded) for 10 years to have bariatric surgery.
As we consider universal, government-run healthcare, this site unveils the reality of implementing overt rationing of resources.
-Wes
That is a very interesting web site. The administrators of Britain's NHS do acknowledge that there IS rationing, and that cost can not be left out of the equation.
ReplyDeleteAs an oncologist, I am frequently in the the position of having to discuss end of life issues -- trying to determine when additional treatment with its attendant toxicities is no longer appropriate. Given that, I also read some of the palliative medicine blogs. On those blogs there are frequent posts and discussions about the difficult cases. However, in the discussion of the ethics of continuing or ending care, there is rarely a mention of the cost to society of continuing care (and lets face it, most of the people who have a family member in that position are not paying for that care out of their own pockets).
In medical school, we are taught to be patient advocates, however, I think we will paint ourselves into a corner if we do not also consider society. The pot is not unlimited. We can not do everything for every patient. If we as physicians do not consider those issues, someone else will consider them for us and we may not like the outcome.
The underlying problem of the burgeoning costs of healthcare is not one that is going to go away. Whatever system you run there is not a bottomless pit of money. If you simplify the problem by saying that you are going to give the patient in front of you everything that he needs whatever the cost you make things easy for yourself. But the reality is that if resources are limited the money you spend on one patient you cannot spend on another. And as has been said above if you ingnore that others will take control.
ReplyDeleteI am not sure why liver transplants were in your example of the 'reality of universal government run healthcare'. Isn't it the number of organs that limits these rather than costs? Which just goes to show that whatever system you run you cannot just consider what is best for the patient in front of you. You have to consider how other patients might benefit from the same limited resource.
That's the reality. Anything else is cloud cuckoo land.