“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?