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Wednesday 23rd May 2018

Healthcare's false economy

5th February 2009

Sophia Christie examines at the "false economy" of healthcare in the Health Service Journal.

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Nick Timmins of The Financial Times showed during a presentation that we are "highly unlikely" to experience growth of 3% by 2011.

The government spends £100 billion on healthcare, which is 29% of the total spend for all departments. Increasing that by even 1% represents a considerable amount of cash. The health service will be competing for money.

Commissions which are carried out at a "world class" standard enable us to anticipate these kinds of changes. In particular, the "competency dedicated to prioritisation"  allows us to objectively assess what is required on a local level, how effective it is and to evaluate the costs.

However, there have been a number of "counterintuitive initiatives" such as the elimination of cancer drug prescription charges.

The initiative which could seriously affect commissioning is the recommendation made by national cancer director Mike Richards to the National Institute for Health and Clinical Excellence (NICE). Professor Richards has said NICE should make changes to "its guidance for technology appraisal to a ceiling of £70,000 per quality-adjusted life year for drugs and technologies in the last year of life."

This announcement was made in December 2008, so many people may be unaware of it. It will be extremely detrimental to any efforts to "commission health gain, or to claim return on investment".

A panel advising on NICE technology were told that £27,000 per QALY was the highest amount considered to be cost-effective. Experts have said this is too much and the figure should be reduced to £12,000-£15,000 per QALY.

Professor Richards has said that private care stays private - without a limit on payment -  and should not be mixed up with being health service treatment.

Professor Richards has managed to pull off what equates to a magic trick by saying that the ceiling for QALYs should be removed for drugs given to terminal patients.

As a consequence "recent growth in expenditure on treatments mandated by NICE has driven out investment on competing local priorities". Cancer medication has grabbed the most funding in comparison to other treatments such as radiotherapy. How can this carry on long-term?

Compulsory spending on oncology medication, in particular for terminal care, could ensure health inequalities remain in practice.

More than 65% of people say they would rather end their lives at home, not in a hospital.

However, if oncology patients are treated with medication "typically billed as lifesaving" then it becomes much harder to prepare for their deaths. This results in death in hospital when a patient is admitted suddenly. Increasing the amount of, and access to, these drugs means more patients will not have the type of death they wish.

It could be that this is actually a "clever" idea. A huge challenge in making the care for terminal patients better is to convince doctors that they should "identify patients who are likely to die in the next year".

If doctors want to use the new medication they will be required to select those patients they believe are terminally ill. Once a formal identification is made then the patient will probably not want to spend their time in hospital receiving "highly toxic substances" and may wish to talk about how they can die in their own home.


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