Saturday, 2 April 2011

When the customer doesn't always know best.

In a News Letter column I argue that health can't be treated in the same way as other products and services if it is provided for free.

Whichever way you spin it, choosing a treatment from a hospital is not the same as choosing a product from a shop. If healthcare is just another part of the market, it is one sphere where the customer is not always right. No-one wants a return to the days of overbearing, uncommunicative doctors, but the philosophy of patient choice can be taken too far, particularly when the taxpayer picks up the tab. 
A patient led service, where GPs are under pressure to provide the treatments people want, rather than those that they need, has its pitfalls. Thanks to the internet, we already have a whole generation prepared to second guess the advice of doctors, on the basis of their own spurious researches. 
The NHS currently has some protection against the pressure of unscientific opinion and popular campaigning. The National Institute of Health and Clinical Excellence (NICE), among other tasks, assesses whether drugs are cost effective or not. Its role as an arbiter could be undermined if consortia are under pressure to provide, for example, costly cancer medication which may add just a few weeks to a terminally ill patient’s life. 
There are already treatments and services, like homeopathy or female sterilisation, which the NHS offers against the prevailing wisdom of doctors, simply because the public demands them. 
The government must be careful that its policies don’t encourage more waste, when the goal should be to eliminate services whose value is doubtful. 
Patients must be properly informed about their healthcare choices, but it’s also important that doctors and the NHS are independent enough to withstand the latest fads and free to exercise their judgement on which treatments are worthwhile.


yourcousin said...

I just conferred with a friend that I went to school with (middle through highschool) whose now a doctor (ER). I asked about whether or not patients demanding unneeded treatment was a major impediment in reducing healthcare costs. Just for the record, he laughed out loud. We did discuss things that could help reduce costs and why those weren't being implemented. But believe me the patients trying to play docter wasn't amongst them.

If you want to cut things that are of questionable value I would suggest you start with the Monarchy. Seriously, how much taxpayer money is being spent for a new princess?

Chekov said...

Fresh from the country which allowed drugs to be marketed direct to patients.

Chekov said...


yourcousin said...

I didn't say that America has healthcare figured out, quite the contrary. That doesn't change my original point. I was genuinely curious about this. I didn't think your point would hold water, but I pulled a Dear Abbey and consulted a primary source. Indeed what spurred me to act was that my friend earned his bachelor in Economics so the issue of the cost of healthcare has been a topic of conversation between us for a number of years now.

But if your entire rebuttal is that private companies are able to directly market to patients then that's on you. I know I don't even qualify as bush league anymore but damn.

The irony of course is that your argument rests upon a market model working for a public service and then you turn around and pointedly sling an arrow meant to highlight the crassness of the American market based system.

Chekov said...

The point I am making is not, in this case, specifically pro-market. As a patient I don't want to be offered a range of 'suppliers' if I'm ill. I simply want to be assured of the right care at my local hospital. And my views on this have developed in conversation with doctors, so I'm afraid our primary sources clash.

RQ said...

It seems easy to say that the NHS should be pared down, and I agree that there are many treatments available free which are completely unnecessary, many of which have been added in by various governments to try and keep their voters sweet. Removing them is difficult, for the same reason. But there are other factors: there's no point hearkening back to the 1950's, it was a completely different world, and the cost of drugs, premises, equipment and staff has ballooned since then. But what can you do about that? Refuse to buy expensive drugs? Put a cap on doctor's wages? Political suicide both.

(maybe they should have hospital bunks instead of hospital beds: that way you could fit twice as many patients into one ward!)

The shift in demographics is another factor - greater longevity and falling birth rates are creating an ageing population, which will strain the system yet more. And, yes, the bureaucracy is crazy, though what do you expect in a system that gets screeds of new legislation thrown at it in every parliament?

In short, the problems of the NHS are so tangled and interlinked that just tackling one aspect is pointless. And yet there isn't the ability - or the will - to take on the whole. Where would you even begin?