Medical Rationing and Healthy Living

The news that there is an “epidemic” of hip fractures and that

GPs have signed off a series of sweeping referral restrictions by NHS managers that will bar smokers and overweight patients from being referred for surgery, as PCTs across the country bring in new cost-saving restrictions.

…set me wondering if there was some sort of structural problem with medicine.

Only a couple of hundred years ago, a great many injuries and diseases could not be treated, and most people didn’t live very long. But as more and more life-threatening injuries and diseases have become curable or treatable, and people have lived longer, it seems that instead of needing less medicine, we seem to need more and more of it. I began to wonder whether the better doctors got at curing things, the more of them were needed, and hence rationing came to be necessary.

After thinking a bit about what might happen in a human population as medicine improved, I decided to do what I so often do in these circumstances: I wrote a little computer simulation model.

In this model, a new cohort of 100 people (i.e. newborn babies) were added every year to a human population consisting of a set of such cohorts, and so the total population grew at this rate. Once I’d got that bit working, I then supposed that there was a 1 in 10 random chance of absolutely anybody having a nasty accident, or catching some bug, and dying. I didn’t suppose that there was any funny business called “ageing” or anything. All death was accidental. When these accidental deaths by injury/disease were added in, the population stopped growing, and instead stabilised at about 1000 persons, with an average age of about 9 years.

I then supposed that whenever anyone had a nasty accident, or caught some bug, they received medical treatment of varying effectiveness. Medical treatment could be 100% effective, or 0% effective, or anywhere in between. And I plotted the total number of medical treatments (both successful and unsuccessful) that were required per year against the success rate of the treatment -which ranged from 0% (completely ineffective) to 100% (complete cure every time). If the treatment was effective, patients lived on until their next mishap. And if it wasn’t effective, they died.

And this is the result I got:

CohortStudy.javaSo, as medical treatment improved, the number of medical treatments  increased. In fact it grew exponentially. The better the treatment, the more of it was needed. And conversely, back when doctors couldn’t cure anything, there wasn’t much work for them to do, as all their patients died.

So it looked like improved medicine simply meant more and more medicine, as more and more treatments were needed. No wonder doctors were being rushed off their feet.

Except that, although the number of treatments grew exponentially with improving treatment success rates, so also did the total population. When medicine was all but useless, doctors were doing 100 (ineffective) treatments a year for a population of 1000 people. But when their treatments were 95% successful, they were treating 2000 people a year in a population that had risen to 20,000 persons. So the number of treatments needed per person remained constant at 1  treatment every 10 years.  The need for medical treatment simply grew linearly with population, and so the numbers of doctors and hospitals grew linearly with population.

So doctors weren’t being rushed off their feet, trying to treat more and more people as their medicine improved. But the population increased, and people lived longer. In fact, in my little model, the mean age of the population when medical treatment was 95% effective was 193 years! And some individuals lasted a lot longer than that.  But leaving that aside for the moment, it meant that when medicine was completely ineffective, doctors would have mostly been treating children of age 9 years. And when their medicine was 95% effective, they were mostly treating people aged almost 200 years old.

I then wondered what difference would be made if the rate at which people got sick/injured was varied. This would correspond to “healthy living” – not smoking, drinking, eating too much (or too little), avoiding doing risky things like walking up and down stairs, etc, etc. I could do this simply by changing the the chance of someone having a nasty accident from the 1 in 10 I’d initially set it as.

To my surprise I found it made no difference at all. Regardless of the rate at which people got sick/injured the overall pattern was the same. Even if people got sick/injured at half the rate, or twice the rate, the number of treatments needed stayed almost exactly the same. What did change was the population: doubling the injury rate halved the population.

So the conclusion of this little mathematical exercise was that, yes, when medical treatment was more successful, more of it was needed. But this was because the population had grown, and people were living longer. The amount of treatment per person needed stayed exactly the same. But also, it made no difference whether people lived “healthy lives” or not, avoiding risks. It didn’t reduce the amount of treatment needed.

In short, there shouldn’t be any need for rationing of medicine, and encouraging “healthy living” is pointless, because it doesn’t decrease the burden on the medical profession.

This is,  of course, a very simple model. And it doesn’t accurately reflect the real world in a number of ways (e.g. not all injuries/diseases are fatal if untreated). And also I may have screwed up the logic somewhere in my little model (which I only wrote this afternoon).

All the same, I thought it came up with an interesting result. Can anyone else replicate it or improve on it?

About Frank Davis

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10 Responses to Medical Rationing and Healthy Living

  1. Jax says:

    I read this article earlier, and it was good to see that all of the comments, from registered member GP’s, were universally condemnatory about this policy. Understandably, there were enormous misgivings around the whole idea of withholding medical treatment for anything other than sound medical reasons. It would seem that (once again) those who claim to be representative of a particular group of people are actually nothing of the sort. No change there, then …

  2. Jax says:

    Dammit! Of course, I meant “anything other than …” rather than “another other …”

    Come back “preview” – all is forgiven!!

  3. Ian B says:

    One big problem I can see with your model is that the need for medical treatment is randomly distributed. In the real world it isn’t; children need quite a lot, then adults don’t need much at all for a while, then they start getting old and need more and more until finally they’re so broken down that nothing can save them, and they die. Hence, a major reason that improved medicine results in a constantly rising per person demand for medicine is that saving people from one illness just lets them get older to get even more, and at an ever increasing rate as they age. Old people cost the NHS a fortune, just by being old. Because old age is a polite term for “worn out and breaking down”.

    We are probably at that stage in the history of humanity (and everyone always forgets that we don’t live at the end of history, but rather live in the midst of it) when healthcare costs are reaching their peak. We can fix loads of breakdowns, but it is difficult (and thus costly) and ultimately futile because death always wins. The obvious next step in healthcare is immortality, and complete freedom from disease, leaving only accidents to claim our lives. May happen this century, certainly by the end of the next century. Depends how eager we are to free ourselves from the burden of senescence evolution lumbered us with. From that perspective, those of us in the resistance movement are very much just holding the line until we aren’t needed any more.

  4. Frank Davis says:

    Yes, in my little model, the need for medical treatment is equally and randomly distributed across the whole population. It could be adjusted though.

    The obvious next step in healthcare is immortality, and complete freedom from disease, leaving only accidents to claim our lives. May happen this century, certainly by the end of the next century.

    Do you really think so? I don’t!.

    • Ian B says:

      Sure. Biology is just mechanics. Being a unit with a design lifetime of about 80 years sucks donkey balls. Nothing is more urgently in need of fixing.

  5. db says:

    My advice to smokers – don’t tell the bastards you smoke (or have smoked). What are they going to do? Force everybody to take cotinine tests, just to make sure?

    If you visit the doctors make sure there are no nicotine stained fingers, and don’t have a cigarette within an hour or two of your appointment. To thwart those with a highly tuned sense of smell wear freshly laundered clothes and perfume/aftershave.

    Unfortunately, five years ago I did tell my doctor I smoked – so I guess I’m a marked man. As is every single person who has signed up for NRT. Indeed, one more reason not to seek NHS ‘help’.

    Whether I smoke or not is entirely my decision and I certainly don’t intend to stop as things stand. In fact, I was a non smoker between September 2006 to Christmas 2010. I don’t believe I would have started again had there been no smoking ban and I had remained ignorant of all their lies.

  6. timbone says:

    You have seen this before, but I will put it into a relevant context for this blog.

    Allegedly, 3.5 billion pounds a year is spent on smoking related illness (does that include ingrowing toenail if patient smokes).

    Now, due to this advancement in treating injury and disease, people can live considerably longer. As a result, many peoples brains are wearing out before other organs do, known as dementia. Now this allegedly costs 23 billion pounds a year.

    So if smokers cost 3.5 billion, and doctors decide they do not deserve medication, why do they think dementia sufferes do, who cost 23 billion. Is it because dementia doesn’t cause ingrowing toenail?

  7. Jonathan Bagley says:

    I registered with a GP sugery last week. I downloaded a registration form and noticed that the second page included an attempt to coerce me into joining the donor register (I recently ripped up the card I carried for thirty years after hearing a doctor suggest that smokers should not receive transplants). In the event, I wasn’t asked to fill in a second page. Perhaps they had received too many complaints. I was asked by the nurse doing the registration, whether I smoked. I said that I didn’t want “smoker” on my medical records and she laughed and said she would put “unknown”. She said my peak flow test was very good for a “possible occasional smoker”. All in all it was a much more pleasant experience than I had anticipated.

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