How much should we spend on healthcare?
BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3714 (Published 03 August 2017) Cite this as: BMJ 2017;358:j3714
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It is good to read Editor's Choice on "How much should we spend on healthcare? "
"How much" - on healthcare? The health care needs & demands vary at each level (Medical institute, State & National), and accordingly the budget allocation. It is different in developing and developed nations.
For budget allocation the following information is needed:
Diseases & their prevalence - epidemiological profile of disease.
Pharmacoeconomics and essential drug list have an important role.
Health education & awareness in society.
Information technology & its role in the health care system.
Knowledge, attitudes & practices - role of health care provider.
Health care services, activities and heath policies at each level.
National heath care system and its priorities - health statistics and peer pressure at international level.
In developing nations, "SWOT" (Strength, Weakness, Opportunity & Threats) analysis is very significant and plays an important part in deciding "How much".
Regards,
Competing interests: No competing interests
Re: How much should we spend on healthcare?
Dear Dr Godlee,
In response to your editorial this week, about Rachel’s article. I think it is appalling
But I personally feel the hours imposed by the European working time directive did enormous harm to medicine in this country. I sense it destroyed the team spirit. In our day if you worked hard your consultant looked after you. If you did not you were left to your own devices. The consultant got to know their junior staff and it worked both ways as regards loyalty.
I am aged (84). As a JHO I was appointed to the Royal Victoria hospital, Belfast, in 1956-7. I was told right at the start my rotations for the year. Three months in general surgery, then neurosurgery, Casualty and finally general medicine. We knew our salary from the BMJ. We were in residence so we did not get any official time off. When we were quiet I got cover from the JHO next door (he later became Professor of Surgery and I still keep in touch with him). There was great bonding in that year’s residence. When I was in general medicine I was invited to a girl friend’s graduation dinner in Edinburgh. I was able to go because the team looked after each other and the senior registrar covered for the 48 hours. I do not remember any SHOs or registrar but we must have had them. (I remember very well that July in 1957 because I developed a pilonidal sinus abscess which burst while I was in Edinburgh and I was injecting myself with penicillin. One does not forget those sort of things!)
In 1956-7 HR got the 24-26 of us (JHOs) to decide on 2 weeks' holiday. I was allocated, and had some choice, of 2 weeks' holiday and went to Geilo in Norway in March. I think we had a JHO, or 2, who covered holidays and that was organised at the beginning of our year.
I recently was at a meeting of the Leicester Medical Society and the administrators have insisted on a joint waiting list for gynaecology. I said to the consultant who was speaking that I thought that was not only crazy but very dangerous. I asked why did the consultants not unite and throw it out? She said “unite” and laughed. That is another problem.
Apologies but you did ask for comments and well done to Rachel.
Yours sincerely
C. A. Jeremy Macafee, MD FRCOG FRCS (Glas)
(Very much retired)
Competing interests: No competing interests