NRL News
Page 10
June 2009
Volume 36
Issue 6

Inadequately Funded Universal Health Care Leads to Rationing:
Part 2—Great Britain
By Roger Stenson with Jennifer Popik, J.D.

NRLC has long argued that the cost of health care does not require rationing lifesaving treatment (see http://www.nrlc.org/MedEthics/AmericaCanAfford.html). As Congress prepares to pass health care reform intended to have universal coverage, it is critically important to include a means of sustainable, adequate funding for it (www.nrlc.org/MedEthics/SaveNotRation.html), so as to lessen the real danger of rationing. The May 2009 issue illustrated what can happen in a national health care system that relies on general fund revenues by describing the rationing common in Canada. In this issue, we look at Great Britain’s rationed health care.

In the United Kingdom, health care is tax-funded and government-run. The government directly pays doctors and pays hospital fees. Patients do not receive bills for National Health Service (NHS) care. All citizens and legal residents are automatically part of this universal system. In terms of financing, 95% of funding comes from taxes and around 5% comes from user charges (for items like co-payments and costs associated with prescription drugs).

Some doctors accept private insurance or fees directly from patients. Almost 10% of Britons use this private alternative in preference to the National Health Service.

Long wait times have become second nature, despite dangerous consequences. In the period between 2001 and 2006, the United Kingdom saw the median wait time increase from 44 to 51 days for hospital admission after the decision to admit had been made. In 2004, according to a BBC report, waiting times in Scotland and England were 8 months for cataract surgery, 11 months for hip surgery, 12 months for knee replacement, 5 months for repairing a slipped disk, and 5 months for hernia operations. In 2007, in 42% of the localities surveyed, hospitals had to turn women in childbirth away because their maternity wards were full.

Former British diplomat Christopher Denne had prostate cancer symptoms and went to his NHS entry-level doctor. It then took six weeks to see an urologist who did not obtain a biopsy for 10 more months. The biopsy was positive for prostate cancer, but Denne had to wait another three months for another test to determine if the cancer had spread. Unfortunately it had, but after more than 14 months, the time for early treatment options had passed.

Waiting times are not the only way in which the NHS rations care. The government’s National Institute for Health and Clinical Excellence (NICE) advises which high-cost treatments should and should not be covered. As reported in the June 8 Time magazine, “NICE uses a metric called quality-adjusted life year (QALY), which grades a person’s health-related quality of life from 0 to 1. ... NICE rarely approves a drug that costs more than 45,000 per QALY.” For example, it recently chose not to pay for two expensive colon cancer drugs for NHS patients.

As a result of this pattern of treatment denied and delayed, a World Health Organization report from several years ago concluded that 10,000 Britons die unnecessarily from cancer each year. A BBC report comparing cancer treatment in the United Kingdom with Third World countries concluded it was worse than in the emerging Eastern Europe of the late 1990s. A conference of the House of Commons All-Party Group on Cancer found that “[a]s many as 55 percent of people diagnosed with cancer in Britain never get to see a cancer specialist,” according to BBC News. The conference also found that five-year survival for colon cancer was 51% in Switzerland and 60% in the United States, yet only 36% in Britain.

Kidney failure also has a dismal success rate. The UK delivers only one-third the per capita use of dialysis for kidney failure as the United States, according to a 2004 National Center for Policy Analysis report.

Next issue: Cuba, the star of Michael Moore’s influential documentary Sicko.