Target high spending areas for rationing

BMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6924.344c (Published 29 January 1994) Cite this as: BMJ 1994;308:344
  1. R P Cole
  1. London SW14 7QF.

    EDITOR, - It is difficult to understand at a superficial level how, if all hospitals provided orthopaedic services at the national average cost, the NHS could achieve savings of over £87m.1 Assuming that the calculations by the Chartered Institute of Public Finance and Accountancy are correct, however, this represents quite a small saving if compared, for example, with recent expenditure on computer systems for the NHS.2 On a more serious note, John Appleby mentions various forms of plastic surgery and infertility treatment as targets for explicit rationing.1 If rationing or priority setting is about containing total spending on the NHS I find it surprising that the debate is concentrated on a few peripheral procedures; even if they were banned only minute overall savings would result.

    It has been estimated that in the United States about half of the budget for Medicare (for the over 65s) is spent on the last few months of life.3 Any sensible debate on priority setting should address the political imperative of cost and tackle the high expenditure area of health care.


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