HARDER AND HARDER TO COLLECT ON BRITISH HEALTH INSURANCE

Smokers may be refused some treatments

Patients with illnesses deemed to be 'self-inflicted' could be denied treatment under guidance introduced by the drugs rationing watchdog. Heavy drinkers or smokers and those who are overweight could all be refused help.

Patients' groups last night demanded to know how far the definition of 'self-inflicted' illness might go. They are concerned it could also cover conditions such as sports injuries.

Details of the guidelines emerged days after health trusts in Suffolk announced that obese patients would be banned from having knee and hip replacements. It appears in a document produced by the National Institute for Health and Clinical Excellence to help decide how new drugs and treatments could best be employed. In the section on self-induced illnesses, the document, entitled Social Value Judgments, says treatment could be withheld if the selfinflicted cause of the illness affects the 'clinical or cost effectiveness' of a drug or treatment. But it adds that NICE should try not to deny treatment to those whose condition is partly or wholly self-inflicted.

Speaking to a Sunday newspaper, NICE chairman Sir Michael Rawlins defended the approach. "Alcoholism rots the liver and if the patient is going to continue drinking, giving them a liver when there is already a shortage of organs is not a sensible use of resources," he said. "We are not punishing alcoholics. It is just that it is pointless spending all that money and using a liver that could be used for someone else."

Patients' groups last night asked who would decide what a 'self-inflicted' illness was. Michael Summers, chairman of the Patients Association, said many people were worried by the events in Suffolk. The NICE guidance would merely add to that concern. "It's a question of where you draw the line. If someone falls down a mountain or hurts himself playing sport, is that self-inflicted?" he said. "And you have to say that some people are not overweight because of their lifestyle. "In some cases, it's something they may have inherited - is that self-inflicted? "I find this whole debate quite disturbing. Is it moral for someone to decide whether or not you are eligible for treatment in this way?"

A poll by the website Doctors.net.uk found one in five doctors said they had withheld treatment from a patient because of their 'unhealthy' lifestyle. A NICE spokesman said last night the guidance was for its own staff. It would not be issued to hospitals or doctors. "NICE will use this to inform the development of future guidance for the NHS on specific clinical conditions," she added.

Five health trusts in East Suffolk, including Ipswich Hospital NHS Trust, are to deny hip and knee replacements to patients who are overweight, it emerged last week. The plans come as the trusts attempt to reduce a 47.9 million pound deficit. The policy was defended by Dr Brian Keeble, who is the director of public health care for Ipswich Primary Care Trust. He said there was 'good science' behind the decision to target obese patients. He added: "Patients who are overweight do worse after operations, particularly bigger and longer operations."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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