Neuro-intervention costs.

Abstract

The majority of the world’s population has very limited access to health care and almost no access to high technology care. Furthermore 89% of annual world health expenditure is spent on 16% of the world’s population concentrating on diseases that have little relevance to the bulk of the world’s population 1. Neuroendovascular interventionists - as well as other specialists - must concede that use of technologically sophisticated equipment and technology contributes to the high costs of providing medical care. It may be argued that these costs are justified by the lives saved and disabilities prevented. As sound as this argument may be, however, it is generally only the lives of privileged people that can benefit from the skills of the interventionist. Many doctors believe that they are ethically obligated to provide the best available level of care to all of their patients, despite the costs. They may reject any responsibility to engage with issues such as health economics, rationing and allocation of limited medical resources. These problems, they would argue, must be solved by politicians, policy makers, and medical authorities - not individual doctors. An alternative view is that interventionists have a moral obligation to help improve the lives of those patients who can benefit from their skills and who are presently unserved or underserved. Following this approach, interventionists would become more engaged in debates about fair, efficient distribution of our limited medical resources. The disparity between people in the world who have education, financial and other resources is increasing. Radical transformation of global economies through the spread of democracy and capitalism have failed to produce a more equitable global distribution of health care. The developing world’s per capita spending on health is often less than 5 USD per annum as compared to the USA’s 4000 USD. The re-emergence of infectious diseases, as well as new diseases like AIDS and SARS, make us aware though that individual health is influenced by global health2. All inhabitants of our planet - rich and poor alike - have a common stake in improving the status of global health. This argument may not seem compelling or relevant to interventionists focused on providing highly specialized care to individuals afflicted by a narrow band of diseases, such as vascular disease. However, doctors must recognize that no effort to rationally and fairly distribute specialty health care can succeed without their cooperation. Doctors working in the developed world can best lead by their example in striving to achieve distributive justice in allocation of limited medical resources in their own countries. Many of the developed world’s health care systems are in trouble. Expenses continue to escalate annually in double-digit figures, and waiting lists for operations and scans get longer3,4. Neither wealthy nor underdeveloped countries can indefinitely sustain the political and economic burden of escalating costs rising and rising expectations of their citizens for better health care. To meet this challenge will require the joint efforts of many stakeholders, and most critical among these are clinicians who care for patients and determine what treatments they should be offered. Many factors limit the wider provision of neuro-endovascular and other specialty care to poorer populations. Among these are the protracted training period, extensive and expensive infrastructure needed, and high costs. Despite these obstacles, interventionists must recognize that they have an ethical obligation not only to advance the level of care, but also to seek to provide decent, affordable care to a larger number of needy patients who cannot pay for the best, most expensive treatment. Inevitably this will require interventionists to make greater efforts to reduce the cost of providing good quality care to patients. But is this practical in wealthy countries in which patients have unre alistically high expectations of their specialists, and doctors rarely act to limit their patients’ appetite for the latest technological advances that make the most extravagant claims?