Thursday, February 21, 2008

NYT: Paying Patients Test British Health Care System

Coming to America?:
LONDON — Created 60 years ago as a cornerstone of the British welfare state, the National Health Service is devoted to the principle of free medical care for everyone. But recently it has been wrestling with a problem its founders never anticipated: how to handle patients with complex illnesses who want to pay for parts of their treatment while receiving the rest free from the health service.

Although the government is reluctant to discuss the issue, hopscotching back and forth between private and public care has long been standard here for those who can afford it. But a few recent cases have exposed fundamental contradictions between policy and practice in the system, and tested its founding philosophy to its very limits.

One such case was Debbie Hirst’s. Her breast cancer had metastasized, and the health service would not provide her with Avastin, a drug that is widely used in the United States and Europe to keep such cancers at bay. So, with her oncologist’s support, she decided last year to try to pay the $120,000 cost herself, while continuing with the rest of her publicly financed treatment.

By December, she had raised $20,000 and was preparing to sell her house to raise more. But then the government, which had tacitly allowed such arrangements before, put its foot down. Mrs. Hirst heard the news from her doctor.

“He looked at me and said: ‘I’m so sorry, Debbie. I’ve had my wrists slapped from the people upstairs, and I can no longer offer you that service,’ ” Mrs. Hirst said in an interview.

“I said, ‘Where does that leave me?’ He said, ‘If you pay for Avastin, you’ll have to pay for everything’ ” — in other words, for all her cancer treatment, far more than she could afford.

Officials said that allowing Mrs. Hirst and others like her to pay for extra drugs to supplement government care would violate the philosophy of the health service by giving richer patients an unfair advantage over poorer ones.
More food for thought:

Page 126-127 of The Undercover Economist by Tim Harford (link to Google Books online with readable text) discusses the idiotic rationing of eye surgery in England. Harford is an Oxford-trained economist very familiar with his country’s healthcare system. Don't miss the 'NICE' irony:
...If you were going blind in Britain, you would be well aware of a recent example of the difficulties faced by such a system. The Royal National Insitute for the Blind, along with other organizations representing people with vision problems, has been campaigning vigorously against a ruling by the National Insitute for Clinical Excellence (NICE), an agency that evaluates treatments and decides whether the National Health Service should pay for them or not. Heart surgery is on the approved list; nose jobs are not.

The controversy stems from NICE's half-hearted endorsement of a new treatment called photodynamic therapy. The therapy uses a drug called "Visudyne" or verteporfin, combined with a low-intensity laser treatment, to destroy lesions under the surface of the eye's retina, usually without damaging the retina itself. If the lesions are not treated they can irreversibly damage the center of the retina, called the macula. The resultant condition, age-related macular degeneration (ARMD) destroys central vision so that the victime cannot recognize faces, read or drive. It is the leading cause of blindness in the United Kingdom.

In 2002 NICE filed a report recommending photodynamic therapy only in more extreme cases, only when both eyes are affected, and only in the eye that is less seriously damaged. The implication is that even treated patients will lose their sight in one eye, while others whose sight might be improved are denied treatment altogether.”...

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