What’s happening in the UK? And, what’s it got to do with us?
In the midst of all the focus on election day in the U.S., there was a much overlooked article the same day on changes in the British health care system. The article is about what is called in Great Britain “NICE.” NICE is an acronym that stands for National Institute for Health and Clinical Excellence. NICE was established in 1999 with a mission to help make evidence based decisions on the use of resources for health care in Britain. It publishes guidelines in three areas:
- The use of health technologies within the British National Health Service, including new and existing medicines, treatments and procedures;
- Clinical practice (guidance on the appropriate treatment and care of people with specific diseases and conditions); and
- Guidance for public sector workers on health promotion and prevention.
Health care in Britain is largely provided through the National Health Service, which is funded through taxes. In many ways, this system makes it clearer that resources are limited and choices must be made as compared to the much more decentralized and fragmented American health care structure. NICE was intended to both help make choices as to what services and procedures (particularly drugs) to cover and to provide more equity in coverage across the country – so that citizens in one part of Britain didn’t have different services covered from those in other parts of the country.
In a 2008 interview with NPR, Michael Rawlins, the head of NICE since its inception said:
“Paying huge amounts of money for every new drug with the faintest hope of extending life by even a small amount would make it impossible for the NHS to provide universal care.
The United States will one day have to take cost effectiveness into account,” he says. “There is no doubt about it all. You cannot keep on increasing your health care costs at the rate you are for so poor return. You are 29th in the world in life expectancy. You pay twice as much for health care as anyone else on God’s Earth.”
Indeed, NICE has been credited by health policy leaders around the world with helping to keep British health costs in line. And, while there has been general support for NICE by the British people there has also been periodic controversy.
In America, the Affordable Care Act included an entity that, when it gets fully up and running, will have some similarities to NICE. The Patient Care Outcomes Research Institute (PCORI) is intended to fund comparative effectiveness research on a range of health services. In its current structure the work of NICE is more explicitly linked to payment and coverage decisions than PCORI. The Affordable Care Act states that, “nothing in the law shall be construed as superseding or modifying the coverage of items or services under [Medicare] that the Secretary determines are reasonable and necessary or as authorizing the Secretary to deny coverage of items or services under Medicare solely on the basis of comparative clinical effectiveness research. “ This provision was inserted to counter charges that health care reform was going to “ration” health care. But, there are still many opponents of the ACA who say that the PCORI is truly intended to ration health care.
So, is America heading down the path that Britain is on and moving towards explicit rationing of care (as opposed to the implicit rationing we do today)? Well, as reported by the Wall Street Journal among others, in fact, Britain’s NICE might be moving to look more like America’s PCORI rather than the other way around. Indeed, the new Conservative led government in Great Britain is planning to limit what NICE can do to be advisory only and allowing drugs to be covered but with varied pricing set through “value based pricing” (hmmm – seems that even that term might have roots in America). And, when will all these changes take place? You guessed it – 2014 – the new Y2K in the health care world in America.
It looks like the pond between America and Britain just got a little smaller –with both countries’ health care systems, which have long been separated philosophically and structurally, coming closer together. Only time will tell whether the confluence is a good or bad thing for either country.