Who gets expensive cancer drugs? And thoughts on rationing
There are lots of assumptions made about the U.S. health care system and how it differs from say, the British nationalized model. In America, everyone has unfettered access to top-notch drugs, while the Brits ration their care, goes the stereotypes. That leads many critics of U.S. health reform efforts to assume the American system is just fine the way it is.
But a new study by Johns Hopkins researchers finds the perceptions aren't so. The study compares the two systems' access to the most expensive cancer medications and asks: Which is more fair? And which cancer patients are better off?
The study, appearing in Milbank Quarterly, compared the costs of 11 pricey cancer drugs. In the UK, seven are free to all patients, with no out-of-pocket costs. Four aren't because they aren't considered worth the limited benefit. If patients want those drugs, they need to pay up.
Here at home, people with insurance have some coverage of all 11 drugs--but the range of out of pocket costs are enormous, depending on the carrier.
Both systems involve a kind of rationing, concludes the study. And here's something that will make reform foes gasp: The issue isn't whether rationing is good or bad, argues the reports' author, Ruth R. Faden, director of the Johns Hopkins Berman Institute for Bioethics. That's because no system can provide patients every medication or intervention to every patient all the time, she writes.
"The issue is what we should do about extraordinarily expensive treatments, some of which do very little to improve how well or how long people live," said Faden in a statement. At the same time, she adds, "there is no ethically defensible reason why some Americans have access to expensive cancer drugs and some do not."
The British system seemed fairer and better able to deal with those wrenching end of life decisions, the authors found.
It's a thorny predicament -- but one every health care system needs to confront: who gets what drugs? Who gets denied? And how to deal with these decisions toward the end of life?
"We're managing health care costs by not allowing some people to be treated at all or forcing them to face financial ruin by getting treatment," Fade says. "Who has an extra $100,000? That's why people sell their homes. That's why people's kids don't go to college. There's probably no more anguishing kind of decision than what a patient and her family face at the end of life."
Categories: Cancer, Health care reform
Comments
That the term rationing has been used to such an extent by some in the health reform debate with the implication of control over choice and lives is very unfortunate. No matter what health care system exists, there are always limits that will be hit. The real question is whether the limit on access to coverage of a drug or procedure is based on medical analysis or financial means.
Deciding that access is based on financial ability alone essentially means that the system is a "free for all" with the most financially gifted having the best access while financial realities ration availability to the less well off. Given that price has no direct relationship with drug or treatment effectiveness, then those who argue for the current system are really arguing that personal choice for themselves is more important than personal health for their fellow citizens. This seems to be a tad selfish.
Posted by: Wellescent Health Blog | December 22, 2009 1:06 PM
As to U.S. drug cos. I have been using drugs from India, and Canada, this with my doctors o.k. Far less expensive and very helpful.
Posted by: Betsy | December 22, 2009 2:29 PM