Prioritization versus rationing of healthcare – elective surgery is not optional surgery: how should priority be assessed to ensure equity?

[摘要] The effect of COVID-19 on healthcare serviceshas contributed to millions of patients waitingfor planned hospital treatment; in Englandalone, more than six million are waiting, ofwhom more than 700,000 are orthopaedicpatients.1 It is estimated that those awaitingsurgery will more than double to over13 million by the end of 2022.2 A healthcaresystem not meeting demand may not beconsidered an equitable healthcare system.Patients deteriorate on waiting lists, withworsening health-related quality of life.3Rationing is inevitable when demand exceedscapacity to deliver, and is always a difficultsubject in universal healthcare systems suchas the NHS.4 However, the need to restrictthe allocation of resources during the initialwave of the COVID-19 pandemic was widelyunderstood and accepted.5 An alternativeconcept to rationing would be the prioritization of services to those who are thoughtto benefit the most from the intervention.4Prioritization does not withhold treatmentfrom patients, but would result in those witha lower priority waiting longer.

[学科分类] 骨科学

[关键词] Prioritization;Waiting lists;Arthroplasty;Elective surgery;Hip and knee arthroplasty;COVID-19 pandemic;cancer;arthroplasty surgery;Hip and knee arthroplasty;total hip arthroplasty;morbidities;hip;chronic obstructive pulmonary disease