Wednesday, September 10, 2008
When radicalism meets reality?
2:01 pm gmt
I was struck this week by the relationship between two separate reports - one from Reform, looking at models of health
funding and the other from the King's Fund looking at the reality of current expenditure patterns on specific diseases.
It'll come as no surprise to most readers here that spending patterns vary hugely, even after accounting for what we
know about local needs (a factor of almost 3 separates the highest and lowest spending PCTs on Mental Health after making
adjustments for need). As the report says, this doesnt yet translate to an analysis of expenditure according to outcome
(true Value for Money), but they suggest that is coming (I wont hold my breath).
So it was interesting to see that report juxtaposed with the Reform piece. This piece (co-authored by Profs Nick
Bosanquet and Karol Sikora) argues for a move to a 'Health Protection' base and insurance for all (with top-ups eg for high
costs drugs), and is clearly an entry in the debate about co-funding (some of you will have heard Prof Sikora on the Today
programme last week on just this last topic).
What this doesnt do for me is deal with the central question of why spending varies so much from one area to another,
with variations that could easily accommodate the sort of expenditure Prof Sikora wants to see on currently 'rationed' drugs
(ie those not yet approved by NICE).
So, if the Reform piece is 'just' a polemic as one commentator opined, should we simply dismiss it? Again for me
the answer is 'no'. We sometimes get so caught up in the justification of what is now that we forget that
other schemes of thinking and offering services can have real benefits, and that they can address such fundamental concerns
as huge and unexplained variations in expenditure.
The debate about co-funding may be an anathema to many healthcare professionals, but we stop thinking about what we are
doing at our peril (and the peril of those we serve).