Intended for healthcare professionals

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Clinical Review

Leukaemia update. Part 1: diagnosis and management

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f1660 (Published 28 March 2013) Cite this as: BMJ 2013;346:f1660

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Re: Leukaemia update. Part 1: diagnosis and management

This fine notice reminded me of hearing Koop speaking in the early eighties on the prospects for the various types of health-care systems. As he saw it, there were three pairs of variables: High quality or Poor quality; Very costly or reasonable; and accessible by all (Availability) or not.

He adduced a great deal of evidence to support his view that no democratic country in the world, at that time, could hope to achieve all three ideals - a high quality generally available health-care system at reasonable cost. He suggested that very rich countries - actually just the USA and possibly West Germany and Japan - might achieve two; he felt the USA had high quality and reasonable availability, but at almost crippling cost. He believed that ordinarily rich countries would be able to achieve only one ideal.
He volunteered that he found the UK an amazing exception with the NHS offering high quality care at a reasonable cost, until he found on closer study that the NHS at that time actually made this possible by practising a very severe form of rationing, by long waiting times for appointments, investigations, and treatments and long waiting lists for operations, of which the populace seemed to be either surprisingly tolerant. He had also found that the doctors managed to get urgent cases to by-pass the queues.

The vote seeking politicians of the day aided by doctors seeking fame combined in a crusade to shorten waiting times and waiting lists. I wonder if the population would have been so supportive if they had understood that this very rationing was what allowed the excellence at relatively low cost of our health service. We now have availability but at high cost and very patchy quality.

Competing interests: No competing interests

07 April 2013
JOHN SQUIRE KIRKHAM
RETIRED SURGEON
RETIRED
19/31 MARSHAM STREET, LONDON SW1P 3DW