nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
See here for more discussion.

Sunday, March 21, 2010

Health Care Rationing: "Ration"-al, But Heartless?

"...most people accept that no publicly funded healthcare system, including the NHS, can possibly pay for every new medical treatment which becomes available."
--Great Britain, National Health Service website on comparative effectiveness.

This is the starting point for medical coverage decisions in most single-payer systems. It's a radical change from the way decisions are made in the US.  You can refer back to the official government website (linked above) to validate the following.

Bear with me on this dull stuff, because the US Congress gave $2 billion dollars to the Secretary of Health and Human Services to design and implement a similar system.  If health care reform passes in some form, and you need care in the coming years, it's important to know, when your care is authorized or denied, how that came to be.  i.e., this is personal.

The British government calculates the justification for coverage by coming up with a way to measure two variables: "extension of life" (in years) and "improvement in health" (assign 0 to worst health, 1 to best health).

Multiply these numbers together to get a Quality Adjusted Life Year (or QALY) for a given treatment. 

Then get data from your system on how much things cost.  If people get a certain treatment and it costs X dollars and their health status is 0.5 and it extends their life one year,  then X dollars gives you 0.5 x 1 = 0.5 QALY.

You make this calculation for two different treatments and come up with a "cost per QALY" for a new treatment as compared to the old.  The official government line is that generally,

"if a treatment costs more than £20,000-30,000 per QALY, then it would not be considered cost effective."
In US dollars, if you don't get 1 QALY for $30-60K of expense, then your treatment costs too much and won't be covered.

Simple, straightforward, rational, cold as ice.  Note that, with the new treatment, if you live 4 years and experience a 0.5 quality of life, but the treatment costs $100K, you may be dead in the water (literally).

Also, note that a bureaucrat can play with the quality number, raise or lower it as necessary, since even with expert opinion it's somewhat arbitrary (What was that about not "coming in between you and your doctor?").

This is the scary part of rational reform--it takes no account of the value you put on your life, or that of your loved ones.  Government decisions like these are why, for some time, Canada and New Zealand denied Herceptin for breast cancer victims, and Great Britain denied drug-eluting cardiac stents for coronary artery disease patients.  Both proven treatments.

Single payer systems work great, as long as patients have common, non-serious illnesses.  They suck when you really need them for complex, cutting-edge, costly treatment.  And how are we supposed to develop new treatments if incremental improvement doesn't meet government coverage criteria?

Feel free to share with your friends.  In health care reform, as in all things, actions have consequences.

Opinions are entirely my own  -- but this is almost completely "just the facts, ma'am."

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