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On the Cost of Bespoking Health Care
Oct. 13th, 2011 12:00 pmI was listening to the Today programme and Andrew Lansley, the Health Secretary was being interviewed. He was talking about we needed to treat people using the NHS as people and not as part of a production process. Then I bumped into a comment about GP prescriptions on LJ. This got me thinking about GP’s and about cost of servicing.
When I go to my GP I’d love to have a half hour consultation that allowed my GP to fully explore the full range of potential health issues I faced and craft an individual regime for me which she would check in with me on in a month’s time.
What I can (or chose to) afford is a ten minute chat where I try to persuade my GP that I’m not trying to get her to prescribe antibiotics for a virus and then she tells me that there isn’t really much wrong with me that she can fix and I should eat better, exercise more and drink less.
I think it likely that in some cases the extra care and attention will allow significantly better diagnosis and / or better treatment with more patient involvement. I wonder if the additional cost of doing this for all cases would be worth it in better health outcomes or better wellness satisfaction outcomes.
I think you would have to have the additional consultation in all cases because there probably isn’t a way to tell in advance if a particular consultation is going to be involved or a more straightforward “Yes, you have a virus. No, there is nothing I can do for you. Go home, go to bed” type.
In some ways, as a citizen tax payer I want the NHS to work like a production line because production lines are an efficent and cheap way of dealing with identical things that need identical things done to them. In many case the improvement in clinical outcome is not worth the increased expense of bespoking the service. In many cases the difference in experiential outcome is not worth the increased expense.
I wouldn’t be happy to pay for a GP or a nurse to go and visit more or less able bodied people in their home to deliver a seasonal ‘flu jab when they could just form an orderly queue outside her office. The wrapper of emotional support that one can put round a patient presenting for a more or less routine cancer screening procedure might make the experience less intimidating but is this extra care and attention a good use of rationed resources? Arguably not.
So I’m left wondering how we make decisions about appropraite levels of bespoking.
Not for the first today I wonder if the accountant’s answer would be understandable or acceptable to the layman.
When I go to my GP I’d love to have a half hour consultation that allowed my GP to fully explore the full range of potential health issues I faced and craft an individual regime for me which she would check in with me on in a month’s time.
What I can (or chose to) afford is a ten minute chat where I try to persuade my GP that I’m not trying to get her to prescribe antibiotics for a virus and then she tells me that there isn’t really much wrong with me that she can fix and I should eat better, exercise more and drink less.
I think it likely that in some cases the extra care and attention will allow significantly better diagnosis and / or better treatment with more patient involvement. I wonder if the additional cost of doing this for all cases would be worth it in better health outcomes or better wellness satisfaction outcomes.
I think you would have to have the additional consultation in all cases because there probably isn’t a way to tell in advance if a particular consultation is going to be involved or a more straightforward “Yes, you have a virus. No, there is nothing I can do for you. Go home, go to bed” type.
In some ways, as a citizen tax payer I want the NHS to work like a production line because production lines are an efficent and cheap way of dealing with identical things that need identical things done to them. In many case the improvement in clinical outcome is not worth the increased expense of bespoking the service. In many cases the difference in experiential outcome is not worth the increased expense.
I wouldn’t be happy to pay for a GP or a nurse to go and visit more or less able bodied people in their home to deliver a seasonal ‘flu jab when they could just form an orderly queue outside her office. The wrapper of emotional support that one can put round a patient presenting for a more or less routine cancer screening procedure might make the experience less intimidating but is this extra care and attention a good use of rationed resources? Arguably not.
So I’m left wondering how we make decisions about appropraite levels of bespoking.
Not for the first today I wonder if the accountant’s answer would be understandable or acceptable to the layman.
