in austere financial times, which procedures should be rationed and who should decide? jason yuen...
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“In austere financial times, which procedures should be rationed and who
should decide?”
Jason Yuen
Final year medical student – University of OxfordProfessor Harold Ellis Medical Student Prize for Surgery
23rd November 2012
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1) Tough financial conditions
2) Ageing population 3) New, expensive treatments
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Economic
ClinicalEthical
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Clinical aspect
Risks of surgery Benefits of surgery
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Benefits of surgery
• QALY?
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• Also consider–Local expertise–Alternatives
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Ethics
– Still “meet the needs of everyone”? – No but we need to consider how to distribute
the resources fairly and “based on clinical need, not ability to pay”
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Costs?
Joint replacement Cataract surgery Tonsillectomy Bariatric surgery Any0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Percentage of PCTs that have restrictions on ‘non-urgent’ or of ‘limited/low clinical value’ operations
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Take home message
• Rationing is inevitable• In order to prioritise procedures, factors to
consider – clinical, economic, ethical– Problems in balancing these– Systematic and fair approach
• The stakeholders
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'You need an urgent operation. But not to worry, I'll make sure you're on my list.'
Any questions?