OP-ED

Health Panels are a NICE Way of Improving Care and Controlling Costs

By ADRIAN BAKER

One of the proposals for health care reform is to have a panel of medical experts oversee Medicare, in order to improve quality and reduce cost. Butfalse accusations permeating the debate have scared people into thinking that would mean a government bureaucrat deciding what treatments you should or shouldn’t have, and would ultimately deny your grandma her vital drugs. Like any debate involving the future, fear of the unknown is going to be used by those who want to maintain the status quo for their own self interest. But health panels are not unknown. They have been used in Britain for ten years, and have proven to work.

Health panels are a simple enough idea: experts look at the evidence out there and make sure it’s the best that is available. They then make recommendations based on analysing hundreds of studies and consulting numerous stakeholders. The recommendations suggest the best form of treatment and care for a particular condition, or advise on areas your doctor may be unsure about.

The recommendations aren’t mandatory, the government isn’t involved, and there is no tying of hands. The decision to follow these recommendations will always be with your doctor, because they know you best. All that happens is that your doctor can make a better, more informed decision and will no longer have to choose between spending time treating you or spending time reading up on the latest evidence.

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Greg PawelskiBKMR QuinnAdrian BakerLevi Lebo Recent comment authors
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Health Plan Veteran
Guest
Health Plan Veteran

While it is nice in theory to leave medical decisions to the patient, their doctor and family, that doesn’t work too well when they’re playing with house money.
I think that the oversight of medical experts is needed to help wade through the emotion and look critically at whether spending of quasi-public dollars on a particular treatment is justified given the medical issues including patient health status.

TheGroupGuy
Guest

“However, one word about QALYS and health panels. As should be the case, health panels such as NICE are completely independent from the government, use fully transparent methodologies and include all stakeholders in the consultation period. Rightly so, it is completely detached from the government, so using QALYS for political decisions is not possible. ” With all due respect Adrian this statement assumes there is agreement that it is even possible to discern QALY’s accurately much less how all life is diminished when mathematical constructs determine its length. Such agreement does not exist. In fact there is great disagreement as… Read more »

Nate
Guest
Nate

“”Under the guidelines the decision to diagnose that a patient is close to death is made by the entire medical team treating them, including a senior doctor”. The guidelines clearly state that the senior doctor and the entire team should make the decision.” This is true but that senior doctor and entire medical team is also an employee of NHS are they not? The same entity setting the guidelines, manages the budget and pays the doctor who makes the determination. I don’t see any independence at any stage. Let’s look at home, look how Clinton sacked the travel office, Bush… Read more »

Greg Pawelski
Guest
Greg Pawelski

I agree with ravi that the debate is not driven by logic but by self interests. Case in point with cancer medicine. Based on clinical trials results showing no difference between single agent platinums versus platinum/Taxol (GOG Trial # 132, ICON3), NICE determined that platinum/Taxol should no longer be considered as “standard therapy” and that a range of therapies are equally acceptable (doctors could think for themselves). In the USA, where the administration of platinum/Taxol has been much more profitable to the treating oncologist than single agent platinum, there has been the dogged insistance that platinum/Taxol remains “standard,” despite clear… Read more »

BKM
Guest
BKM

I don’t understand how this differs from what we have to day, which is insurance companies making the decision. I know a family whose child has a rare pediatric cancer called neuroblastoma. All high risk neuroblastoma cases are treated on clinical trials designed by COG. That is the standard of care – in fact, there are no treatments outside of clinical trials. This family was randomized to a tandem transplant on the current COG Phase III trial. But their insurance company is refusing to pay, saying that this is experimental. I am not seeing how this is any different from… Read more »

R Quinn
Guest

Sounds fine in theory, but you should really have mentioned QALYs and how they are used in the UK (or interestingly how they may have been used in a case such as Sen. Kennedy’s condition and age.
The American people do not understand that to have any hope of managing health care costs, there has to be a way to, well, manage those costs. Call it rationing or call it managed care … oh wait we all ready tried that and screwed it up.
http://www.quinnscommentary.com

Adrian Baker
Guest
Adrian Baker

Many thanks for all your comments. Just to pick up on a couple of points: With regards to the letter in the Daily Telegraph (it should be noted, however, that the DT is not impartial, and neither are the people they quote), I think this statement should be emphasised: “Under the guidelines the decision to diagnose that a patient is close to death is made by the entire medical team treating them, including a senior doctor”. The guidelines clearly state that the senior doctor and the entire team should make the decision. Robert, you make some good points. You’re right… Read more »

Peter
Guest
Peter

It’s refreshing to see Republicans so concerned for the helpless and disadvantaged (political crocodile tears?). Too bad they can’t entend that heart felt concern to the millions who suffer premature death from not being able to pay for medical care.

Levi Lebo
Guest
Levi Lebo

I firmly believe we need a public option that will not eliminate people when they get sick or raise deductibles so people can’t afford to use their health insurance when they need it. This is more than a fight to include the uninsured. This is trying to preserve an option for the middlle class at all.
The private health insurance continue to raise rates while the CEO’s and top officers of these private companies pocket millions of dollars. How can a company
that pays its executives millions of dollars in bonuses be call non-profit any way.

TheGroupGuy
Guest

“In 2007-08 16.5 per cent of deaths in Britain came about after continuous deep sedation, according to researchers at the Barts and the London School of Medicine and Dentistry, twice as many as in Belgium and the Netherlands.”
Who would have thought republican obstructionists had such a covert network that included palliative care providers in the UK? Imagine the planning that took for Gingrich & Palin.

Nate
Guest
Nate

Adrian, Is this the type of panel you are suggesting? http://www.telegraph.co.uk/health/healthnews/6127514/Sentenced-to-death-on-the-NHS.html “In a letter to The Daily Telegraph, a group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death. Under NHS guidance introduced across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away. But this approach can also mask the signs that their condition is improving, the experts warn. As a result the scheme is causing a “national… Read more »

Doc99
Guest
Doc99
DrWonderful
Guest
DrWonderful

I’ll take my chances on working with a legislator that can be voted out of office rather than dealing with a panel full of biased and self serving agendas, thank you.

Peter
Guest
Peter

Detach the billed dollars from care and see how fast we won’t need “Qualy Metrics” to control health dollars.

Electronic Medical Records
Guest

Indeed a NICE way.Improving care and also controlling costs sound amazing.