Resource Allocation
Healthcare represents one of the largest expenditures in the world for governments. The NHS accounts for just over 8% of the UK GDP in 2010 (up from 5.5% in 2000) to 110 billion pounds spent.

The population is getting older, and there is an increase in co-morbidities, requiring an endless pit of resources.

Under the UK, there is a limit to the resources available (manpower, drugs and procedures). This means waiting lists, NICE policies on treatment protocols, and limitations to screening programs.

Priorities in the allocation of resources

This has to take into account not only of the prevalence but also the seriousness of the condition. Prevalence meaning both mortality as well as morbidity.

What priorities should be given to those with the worst prognosis?

When should small benefits to a large number of people outweigh large benefits to a small number of persons?

Consideration of costs has become part of medical training and frequently we are told to order the cheapest rather than the best investigation first (compare that to the US where every single A&E seems to have a CT scanner!). With the advent of reforms to the NHS and GPs having more say in the allocation of resources, the difficult decision that they are forced to make on a daily basis will now be clouded by finical consideration more so than ever before.


NICE (National Institute for health and Clinical Excellence) use QALYs (Quality Adjusted Life Years) as a measure of health-related outcomes as related to cost-effectiveness.

QALY tries to quantify the length as well as quality of life gained by an intervention.

  • The lower the cost of QALY the greater the efficiency of a healthcare system

The current debate surrounds rare diseases and the very expensive drugs that can be used to treat it. Applying the NICE cost-effectiveness guidelines, it would deprive these rare patients with the drugs that they need the most. But what happens if you are deciding on treatment between 2 different therapies for 2 different patients both with the same QALY?

Ethics of resource allocation

Utilitarian: Striving the greatest good for the most amount of people would favour public health initiatives (vaccination, the proposed "polypill" to reduce cardiac events) but deny expensive treatments (intensive care or say transplants)

Libertarian: People in the UK have no right to treatment, but the rich can have private healthcare insurance and thus are able to pay for it like any other commodity.


Despite all that is said, who can truly judge another person's life? Everyone has different thresholds and values for different reasons.