Posts Tagged ‘nhs’

The PolyPill – an analogy for NHS reform, and the efficiency myth

In Health, Marketing on May 30, 2011 at 9:16 pm

Some medical authors have called for all over-55s to be given cholesterol lowering drugs as a more cost-effective route to a better outcome for all:

Thinking through how this proposal might be applied, and the alternative, highlights an interesting point about the advantages and disadvantages of policy ‘for the many’ or ‘for the greater good’, as against the concept of choice as preferred by successive Governments with regard to the NHS.

The concept of choice as a positive is embedded in our culture, with regarding commerce and capitalism. Choice ensures money get’s to where demand (or need) is greatest, and drives down cost by encouraging competition etc, etc…you know the deal.

This is the concept that many believe will help the behemoth of the NHS move its enourmous budget to where need is greatest, and make sure those treatments also become cheaper.

However, in healthcare there’s an additional complication – the greater good. Most people in the UK still hold by the ideas behind the NHS, even if not the reality – eg/ that the overall idea is to try and raise the overall health of the entire population in all areas. Part of this can mean spending money where it isn’t necessarily ‘needed’, such as in preventative medicine, or in associated schemes such as education (to promote contraception, healthy lifestyles etc..)

In current policy thinking, anything which is decided and impemented across the board is called ‘inefficient’. They call it this because some of the money will be wasted on people who don’t need what is offered, or people of differing needs get the same treatment.

This is true. However, does this necessarily mean it is inefficient? Efficiency actually relates to the overall outcome measured against the overall effort put in (time, money, energy etc…).  Whilst everyone abhores waste, waste can be part of an efficient outcome.

And so we come to the research on the Polypill. Unlike current thinking, it makes the simple conclusion that sometimes mandating a treatment, rather than giving people choice, can be more efficient. Some will feel the effect more than others, and there will be waste and side effects, but sometimes when given choice, people decide against things that are good for themselves, and for the population as a whole.  Note the recent rapid rise in Measles on the back of parents choosing not to give their children the MMR jab, and thereby exposing their own and other children to an horrendous and easily preventable disease.

I’m not necessarily against ‘efficiency’ based reforms, just the concept that choice automatically creates efficiency. It doesn’t.