4 ms·

The evidence is out there in published papers that do health economic analyses of various interventions. On a population based level it makes perfect sense to

by refurb 2y ago

The evidence is out there in published papers that do health economic analyses of various interventions. On a population based level it makes perfect sense to not do things even if it could save lives. This is exactly what NICE does in the UK. If it costs more than 30,000 GBP to give one person one more full quality year of life, then it’s not worth it.

vidarh 2y ago
To the point about NICE, it's worth pointing out that this is 1) not how NICE decides. Average cost per QALY being below the preferred level is one factor. Analysis of treatments they approve suggests the "actual" threshold is closer to 45k. 2) These are averages per treatment or protocol and in most areas the NHS spends less than the threshold by simply delivering based on clinical assessment of benefits, and so the threshold is limiting treatment mainly on the fringes where you find a few very expensive treatments with marginal benefits with no cheaper alternative. In practice NICEs threshold is what any insurer would do: You know how much money there is in the system and try to maximise health output with what is available to you.
- refurb 2y ago
  In practice NICEs threshold is what any insurer would do This is what makes Americans getting upset their insurance rejects coverage for medicines so ironic. Single payer systems do the exact same thing. The difference is in the UK is the option is just isn’t brought up in the first place because the doctor already knows it’s not paid for.
  - vidarh 2y ago
    Even then, they'll happily bring it up if you mention you're fine with private referrals or recommendations for something that isn't covered. Almost all single-payer systems are single-payer only in the sense that everyone is covered by the public system, but without preventing people from going outside it. A very few - Norway used to - strictly limits what you can go outside the system for. In the UK about 10% have private insurance on top.
    - refurb 2y ago
      Right. So if you have the $$$
      - vidarh 2y ago
        Typical insurance costs in the UK are extremely low compared to the US though. Most health insurance is "top up" based, in the sense that it covers things the NHS doesn't do well enough, like shorter waiting lists for some elective procedures. The average cost of private health insurance in the UK is ~$114/month.
        refurb 2y ago
        Of course it’s cheaper it covers much less. The US insurance pays for everything. UK insurance layers on top of the public system. Plus UK insurance excludes pre-existing conditions. In the US you can get diagnosed with cancer and then buy insurance to pay for it.

by refurb 2y ago

vidarh 2y ago

To the point about NICE, it's worth pointing out that this is 1) not how NICE decides. Average cost per QALY being below the preferred level is one factor. Analysis of treatments they approve suggests the "actual" threshold is closer to 45k. 2) These are averages per treatment or protocol and in most areas the NHS spends less than the threshold by simply delivering based on clinical assessment of benefits, and so the threshold is limiting treatment mainly on the fringes where you find a few very expensive treatments with marginal benefits with no cheaper alternative. In practice NICEs threshold is what any insurer would do: You know how much money there is in the system and try to maximise health output with what is available to you.

refurb 2y ago
In practice NICEs threshold is what any insurer would do This is what makes Americans getting upset their insurance rejects coverage for medicines so ironic. Single payer systems do the exact same thing. The difference is in the UK is the option is just isn’t brought up in the first place because the doctor already knows it’s not paid for.
- vidarh 2y ago
  Even then, they'll happily bring it up if you mention you're fine with private referrals or recommendations for something that isn't covered. Almost all single-payer systems are single-payer only in the sense that everyone is covered by the public system, but without preventing people from going outside it. A very few - Norway used to - strictly limits what you can go outside the system for. In the UK about 10% have private insurance on top.
  - refurb 2y ago
    Right. So if you have the $$$
    - vidarh 2y ago
      Typical insurance costs in the UK are extremely low compared to the US though. Most health insurance is "top up" based, in the sense that it covers things the NHS doesn't do well enough, like shorter waiting lists for some elective procedures. The average cost of private health insurance in the UK is ~$114/month.
      - refurb 2y ago
        Of course it’s cheaper it covers much less. The US insurance pays for everything. UK insurance layers on top of the public system. Plus UK insurance excludes pre-existing conditions. In the US you can get diagnosed with cancer and then buy insurance to pay for it.