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LETTERS: Michael A McDowall Ageism in services for transient ischaemic attack and stroke: Ageism or cost-benefit analysis? BMJ 2006; 333: 656-b [Full text]

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Demand for health care - a bottomless pit?

Robert G..A. BEHRMAN   (25 September 2006)

Demand for health care - a bottomless pit? 25 September 2006
Robert G..A. BEHRMAN, Consultant Heatherwood Hospital SL5 8AA Send response to journal: Re: Demand for health care - a bottomless pit?	Dear Sir, The argument for rationing health care is usually justified by the bald statement that it is inevitable and therefore the country needs to have a debate about how it can be most fairly carried out. Michael McDowall’s letter (1) falls into this category by stating “we must face up to the reality of resource restrictions”, whilst nevertheless failing to produce any evidence that restrictions are indeed a necessity. We seem to be talking ourselves into this position without any attempt to analyse the position. There is a danger that the inevitability of resource restrictions for health care is becoming a factoid - a statement quoted so frequently and widely that it eventually gains veracity merely from ubiquity. There is often said to be a bottomless pit of demand for health care. However, this is surely a hyperbole. Illness resulting from conditions which have medical or surgical treatments is limited (although admittedly is increasing over the years with changing demography and medical developments). Therefore, theoretically, it would be possible for the nation to spend a sufficient sum to be able to cope with this finite demand. Whether people would be willing to tolerate the necessary increase in their taxes is surely the first question that needs to be put to them. If the answer is negative, then would be the appropriate time to debate where cuts should fall, depending on what sum they would accept paying. If the nation is expected to decide which aspects of their health care they wish to be rationed, then it is surely for the people to first decide the level of NHS funding that it would like to expend, and only after that, where the cuts, if any are necessary, should fall. Yours faithfully, Robert Behrman (consultant geriatrician and stroke physician) Heatherwood and Wexham Park Trust, Berkshire SL5 8AA 1 McDowall M. Ageism or cost-benefit analysis? BMJ 2006;333:656 Competing interests: None declared