Rationing: an open secret?

摘要

The NHS in England has announced that, as part of its strategy to save money and move towards a sustain-able healthcare provision model, it will potentially no longer provide 1 7 surgical treatments routinely. Some of these are surprising at first glance and impact directly on orthopaedic surgeons. Two orthopaedic procedures - knee arthroscopies for osteoarthritis and injections for non-specific back pain - are only to be provided on an individual request, with limited evidence of clinical effectiveness cited. Further procedures - subacromial decompression, carpal tunnel surgery, ganglion excision, trigger finger release, and palmar digital fasciectomy - are to be offered only when very specific criteria are met (usually the exhaustion of conservative options). Whilst this is an overt attempt to ration - and there are other examples (for example, triage for joint arthroplasty in New Zealand is, in many areas, now based on the Oxford score)-the rest of the world is also struggling to pay for its health care and is taking different approaches.