How important is research in shaping policy when a new life-saving medical technology becomes available, but happens to be very expensive ?
Taking the case of kidney dialysis, this paper argues that the emerging discipline of health economics had little influence relative to national differences in health service organization and cultures of expectation of provision.
Paradoxically, the most effective covert rationing was achieved under the British NHS which ostensibly provides free care for all, while the uncentralised market system in the US gave way, on this issue, to almost universal state-subsidised provision.
Under the British system, the most cost-effective options for renal care tended to flourish, but some patients were turned away.
Physicians have been held responsible for complying with covert rationing : this paper suggests that early gearing towards socially-useful survival filtered back to selection at primary level, possibly continuing long after specialists wished to expand.
Public outcry, though muted, reached parliament and caused minor shifts in policy ; the main aim of the voluntary pressure campaign, to release more organs for transplant through'opt-out'remained unrealised in the UK.
Yet dialysis was targetted for expansion in the 1980s just at the point when health economists were presenting evidence for its low cost-effectiveness compared with other expensive interventions. (...)
Mots-clés Pascal : Insuffisance rénale, Homme, Traitement, Dialyse, Système santé, Economie santé, Rationalisation, Etats Unis, Amérique du Nord, Amérique, Grande Bretagne, Royaume Uni, Europe, Etude comparative, Appareil urinaire pathologie, Rein pathologie
Mots-clés Pascal anglais : Renal failure, Human, Treatment, Dialysis, Health system, Health economy, Rationalization, United States, North America, America, Great Britain, United Kingdom, Europe, Comparative study, Urinary system disease, Kidney disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0460277
Code Inist : 002B27B03. Création : 22/03/2000.