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In austere financial times, the issue of rationing procedures becomes crucial. Who should decide which procedures are prioritized? With tough financial conditions and new expensive treatments, balancing the needs of an aging population poses challenges. This essay by final year medical student Jason Yuen, who received the Harold Ellis Medical Student Prize for Surgery, delves into the clinical, ethical, and economic aspects of this dilemma. Exploring the benefits and risks of surgery, the concept of QALY (Quality-Adjusted Life Years) is discussed along with the importance of local expertise and ethical considerations. While it is acknowledged that rationing is inevitable, the key lies in prioritizing procedures based on clinical need rather than ability to pay. A systematic and fair approach, considering stakeholders, is necessary in addressing these complexities.
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“In austere financial times, which procedures should be rationed and who should decide?” Jason Yuen Final year medical student – University of Oxford Professor Harold Ellis Medical Student Prize for Surgery 23rd November 2012
1) Tough financial conditions 3) New, expensive treatments 2) Ageing population
Clinical Ethical Economic
Clinical aspect Benefits of surgery Risks 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”
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
Any questions? 'You need an urgent operation. But not to worry, I'll make sure you're on my list.'
