Academic journal article The Hastings Center Report

The "Real-Life" Death Panel, Reformed

Academic journal article The Hastings Center Report

The "Real-Life" Death Panel, Reformed

Article excerpt

The United Kingdom's coalition government has just begun the most sweeping overhaul of the National Health Service since its inception. (1) Under the reforms, 80 percent of the NHS budget will be handed over to about five hundred local consortia of primary care physicians, who will be empowered to make medical spending and allocation decisions for their patients. The 152 existing Primary Care Trusts (PCTs), which purchase hospital and community care for patients and oversee primary care physicians in their regions, will close their doors, leaving local doctors with the power to decide which interventions are appropriate, and which too expensive. (2) Hospitals and community service providers will have greater freedom from government supervision and potentially greater access to private capital. Every element of the NHS is being redesigned to increase competition and decentralize decision-making.

One of those elements is the National Institute of Health and Clinical Effectiveness, or NICE. NICE serves a number of functions within the NHS; it has, for example, garnered considerable praise for improving care by developing high-quality clinical practice guidelines. But its most controversial role has been that of "rationer-in-chief."

NICE evaluates the cost-effectiveness of new medical technologies, especially drugs. Approval of a drug effectively mandates that PCTs purchase it for patients who need it. In recent years, NICE has denied approval to a small number of high-cost cancer drugs, primarily on grounds that their costs greatly exceeded NICE's threshold of 30,000 [pounds sterling] per quality-adjusted life-year saved. NICE's denials are not technically binding on PCTs, but expensive departures from NICE's recommendations are rare in the cash-strapped NHS. NICE's denials of cancer drugs have met with vehement opposition from the pharmaceutical industry, patients' rights groups, and the British press, which has cast NICE as a heartless, penny-pinching bureaucracy, willing to condemn patients to death because of money.

Readers may recall that NICE had its moment on the American political stage during the debate on the Obama health reform law. NICE was held up by conservative commentators and bloggers as an example of a real-life, socialist, bureaucratic "death panel." This characterization, supported by the hyperbolic British press coverage, led Congress to amend the health reform law. …

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