Choice, Equality and Cost
Chapter 16: Cost containment
The share of care is going up. It is going up as a share of the gross domestic product (GDP), of total public expenditure and of the median household budget. There is nothing wrong with that. If society wants better health, and if it is convinced that more care is the best means to the end, then it ought to welcome the rise. We do not cut or curtail the cost of something that is doing us good. The question is simply whether an equivalent health status can be delivered at a lower unit cost. This chapter explores the possibility that it can. There is no consensus on medical effectiveness, value for money or clinical priority. There is no consensus on the target share of health. Where there is consensus is that spending is escalating and that the price times the quantity is becoming a threat. Choice in health must extend to the choice of cost: ‘Health care expenditures cannot grow at rates 2 per cent or 3 per cent higher than GDP indefinitely’ (McGuire et al., 2012: 140). At some point the members of the community must call a halt. What that point will be is, however, not a matter for doctors or even economists to prescribe: ‘Ultimately … the level of expenditure will be determined by the preferences for health care displayed by individual countries’ (McGuire et al., 2012: 142). Each country’s consensus is the suprema lex. Agreement is all. Without agreement it would be civil war.
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