Scottish NHS Rations By Queuing – Why Not Do It By Price Instead?


Anything and everything in this world – anything which is an economic good at least – is rationed in some manner. That’s rather what an economic good means, something which is scarce and thus we need some limitation on its use. This is as true of health care as anything else. We also have a system which acknowledges this, NICE. If your treatment is going to cost more than £30,000 per quality adjusted life year then you’re not going to get that treatment. We can spend that money better elsewhere giving other people more life years than upon you.

So, some disgusting and expensive to treat disease you’ve got? Well, happy death. And some system which does this is necessary as we can’t treat everything that everyone has got. Even if we devoted the entire resources of the country to trying to do so people would still die.

The thing is, trying to avoid such difficult decisions doesn’t mean the need for such rationing goes away. It just ends up being done in some other manner:

Scottish NHS patients have been forced to wait more than two years for their treatment despite Nicola Sturgeon’s legally binding guarantee promising them help within 12 weeks, it has emerged. The Liberal Democrats published official statistics obtained using the Freedom of Information Act showing more than 12,000 people have had to wait more than six months and 450 at least a year until their treatment started. In two cases, both recorded in troubled NHS Tayside, patients have been forced to wait more than 800 days for help – far in excess of two years.

Ration by queuing. That’s what the NHS generally does as well. It’s actually the one grand difference between the US health care system – that much maligned one over here – and our tax funded one. If you’ve got health care coverage in the US the one thing it really does well is treat you fast. Got cancer? You’re on chemo the next day if not that afternoon. The NHS promises that you’ll see the specialist soon enough as our alternative. Soon being defined in weeks.

It’s not entirely obvious that this rationing by wait is a better system. But that’s the one we’ve got and perhaps we might want to think about changing it?