Education And Debate

Commentary: Reach beyond metaphor to assess value

BMJ 1996; 313 doi: (Published 20 July 1996) Cite this as: BMJ 1996;313:154
  1. Ian Harvey, consultant senior lecturera
  1. aDepartment of Social Medicine, University of Bristol, Bristol BS8 2PR

    The case of this child could, like that of child B, have easily developed into a contested issue. The prognoses were equally dismal and the projected cost of child B's transplant was actually less (£75 000)1 than that of one year's home ventilation. Yet the purchaser's agreement to fund the child's care should not be taken to mean that there are no thorny issues.

    Firstly, let me deal with matters of fact. The cost of home ventilation for this child is estimated at £160 000. Was this greater or less than the cost had she remained in hospital? Published reports on this subject, mainly from the USA, generally assert that costs to health care purchasers are lower at home,2 but this is critically dependent on who delivers home care. …

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