“In austere financial times, which procedures should be rationed and who
should decide?”
Jason Yuen
Final year medical student – University of OxfordProfessor Harold Ellis Medical Student Prize for Surgery
23rd November 2012
1) Tough financial conditions
2) Ageing population 3) New, expensive treatments
Economic
ClinicalEthical
Clinical aspect
Risks of surgery Benefits of surgery
Benefits of surgery
• QALY?
• Also consider–Local expertise–Alternatives
Ethics
– Still “meet the needs of everyone”? – No but we need to consider how to distribute
the resources fairly and “based on clinical need, not ability to pay”
Costs?
Joint replacement Cataract surgery Tonsillectomy Bariatric surgery Any0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Percentage of PCTs that have restrictions on ‘non-urgent’ or of ‘limited/low clinical value’ operations
Take home message
• Rationing is inevitable• In order to prioritise procedures, factors to
consider – clinical, economic, ethical– Problems in balancing these– Systematic and fair approach
• The stakeholders
'You need an urgent operation. But not to worry, I'll make sure you're on my list.'
Any questions?
