Recent decisions by the rationing body of the UK National Health Service have placed drugs and treatments out of reach for patients based primarily on the question of cost.
In a September decision, the National Institute for Health and Clinical Excellence (NICE) found the drug cabazitaxel was not sufficiently cost-effective to justify the treatment of prostate cancer. Although NICE found the drug did indeed extend the lives of patients with advanced prostate cancer, it stated it was “concerned” the average cost of the treatment was too high.
The move followed a report published by Lancet Oncology, assembled by 37 oncologists, which maintained the cost of cancer care is becoming unsustainable, and that end of life care should be reconsidered.
“Evidence shows that a substantial percentage of cancer care spending occurs in the last weeks and months of life, and that in a large percentage of cases, such care is not only futile, but contrary to the goals and preferences of many patients and families if they were adequately informed of their options,” the report found.
‘Waiting Lists Are Rising’
According to Eamonn Butler, director of the Adam Smith Institute in London, cancer care is not the only area subject to increased rationing in the United Kingdom. Hip replacements, cataract surgery, and tonsil removal are among operations now being rationed in a bid to save money.
“With no price barrier, the demand for medical treatments of all kinds greatly outstrips the supply. This has led to continual shortages in the service and to long waiting lists,” Butler said. “By the 1980s, some people were waiting three years for hip operations, two years for eye cataract surgery, and so on. A huge injection of money under the last administration saw waiting lists come down, but most of the extra money simply went into doctors’ and nurses’ salaries. Now that funding is tight again, waiting lists are rising.”
Hospitals have been given waiting time targets by the government in an attempt to make sure people are seen more quickly. But Butler says hospitals routinely game the system.
“They fudge the definition of when the patient was first referred to treatment, or instruct doctors to tell patients that their condition does not require treatment, or even advising them to go to the private sector. The existence of a time limit also means that hospitals don’t bother to use their capacity treating patients quickly, but fill up their operating theatres with cases that are just about to exceed the time target,” explained Butler.
‘Rationing . . . Cheats the Public’
Butler says NHS rationing is based on an empty promise to the public.
“The rationing problem cheats the public. In many cases they need treatment but do not get it, and are not even made aware by the clinicians that they need it or that their condition would be improved by surgery,” Butler said. “Tens of thousands of people decide instead to use the private sector, or go abroad for operations, rather than endure constant discomfort and pain. Even though they have already paid for the NHS through their taxes, they are willing to pay again.”
Sally Pipes, president of the Pacific Research Institute, says the NHS cannot survive without reform.
“The NHS, Britain’s government-run health care system, has been in deep trouble for many years. It has to be reformed,” said Pipes. “There are more than a million British people on waiting lists for surgeries and treatments. The public realizes that the NHS is not working.”
Yet Butler notes UK citizens are “paranoid” about losing their current system.
“The public remains very concerned about changes to the NHS, which they fear may give rise to an ‘American-style’ system in which millions of people ‘cannot afford’ insurance and doctors ‘check your wallet before they treat you,'” Butler said.
U.S. Rationing Future?
Pipes says under President Obama’s health care law the United States will face many of the same challenges Britain has.
“We must not follow the policies of countries like Canada and Britain. If we do, we will face the same problems that they have and the American people will not be happy,” Pipes said. “We must replace Obamacare with a consumer-focused, patient-centered system.”
Butler says the rationing that occurs in the NHS could have been avoided had politicians chosen a different course.
“Towards the end of her administration, Margaret Thatcher introduced an ‘internal market’ system into the NHS, which was only just beginning to show results when it was abolished by the Tony Blair government in 1997. Towards the end of his decade in office, Blair began to see the merits of this market system and tried to reintroduce it—but was stymied by his own party,” Butler said. “The present coalition has had to delay its reforms because of criticism from NHS workers and Liberal Democrat party members.”
Calls Market Only Alternative
Butler advocates a market-based alternative as the only solution.
“Rationing can only be prevented through the adoption of a proper price system for medical care. We do not have state supermarkets or state clothes and shoe stores. We let the market provide these things, and if people cannot afford them, we give them the money to give them access to that market. We should deliver healthcare in the same way,” Butler said. “Only major reform is going to prevent severe rationing of healthcare in the UK.”