Letters Patient pathway improvements

Patient centred comes at a price

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b861 (Published 03 March 2009) Cite this as: BMJ 2009;338:b861
  1. Peter A West, senior research associate1
  1. 1York Health Economics Consortium, University of York, York YO10 5NH
  1. paw11{at}york.ac.uk

    The potential cost of more rapid access to services should not be overlooked.1

    Queueing models show how rapidly costs rise with the shortening of the queue. To see a dermatologist in two days means having a lot more dermatologists who either cost more or get paid less. Either way they have to be less busy to make sure there will always be free slots at short notice. In addition, the result of greater convenience for all would mean many more people working unsocial hours, or less convenience for many.

    Part of the issue here is that the patient is depicted as a high powered executive whose work is so important that only a cancer scare can displace it.1 How many of us really begrudge our colleagues, our postman, our builder time off to go to see a doctor? Perhaps we also need to put the importance of work in proportion and consider that our health might just be worth taking some time off to check it, particularly if the cost of a much more accessible system will be much higher.


    Cite this as: BMJ 2009;338:b861


    • Competing interests: PAW is a health economist who works on a wide range of evaluations and projects for the NHS, other public sector bodies, and the private sector, including pharmaceutical companies. He is not working currently on patient pathway improvements.


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