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Is rationing down under upside down?

BMJ 1998; 316 doi: (Published 18 April 1998) Cite this as: BMJ 1998;316:1251
  1. Benjamin Bridgewater, visiting cardiac registrar
  1. Auckland

    In January 1997 a report of a rationing system for coronary artery surgery (CABG) in New Zealand was published in the BMJ. This described the development of a priority scoring system for patients with angina whereby a panel of experts gave weightings to various factors thought to influence the benefit derived from surgery, such as the degree of coronary disease, severity of angina, and ability to work and live independently.

    These factors add together to give a priority score, with a maximum of 100. This system was piloted on a group of patients presenting for CABG, and the cost of providing surgery to patients above certain levels of clinical priority was calculated. The clinically desirable threshold was deemed to be 25, but with current levels of government funding it was decided by the minister of health that CABG could be provided only to patients scoring more than 35 points.

    In June 1997 I started a year's sabbatical in cardiothoracic surgery in Green Lane Hospital in Auckland where I have watched this system in action. There are major differences in the way in which the service is provided. In …

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