Rationing has turned into a politically charged word which immediatly causes visceral repulsion for most americans. Cost effective analysis is a tool by which we may choose to ration a particular treatment or procedure.
Who should make rationing decisions in the US is an issue that separates the left and the right in our country along legitimate philisophical differences.
Rationing at the cash register is what we are accostomed to in the US. Not everyione gets a Cadillac, but we are comfortable with that within reason. Problem is that the consumers (patients and physicians) are no were near the healthcare cash register.
Rationing through a central power structure makes many in the US suspicious, and hence one of the reasons the Democrats struggle.
Even though I am philosophically a believer in rationing through the market, the goverment is so far into healthcare already I do not see any way that we can feasably unwind it enough to even try a true market solution.
By the way, Botsford now has a Davinci - Hey, we can't compete on price, so we have to compete with technology!
So here is the question: if you had to have a prostatectomy, would you choose to have it done using a Davinci, or the 'old fashion way' as an open procedure (assuming that you have good insurance and price is no object)? It is the question I had to ask myself as we contemplated the purchase of a Davinci. My honest answer: I personally would choose a robot because even though you are right in that there is no data regarding a cost effectiveness benefit, there is a huge benefit in recovery time; with an open prostatectomy recovery can be weeks, but with a Davinci it is usually days. Hey, I'm a wimp and I do not like pain. This is not measured in most cost effectiveness studies.
But, if I had to pay an extra $20,000 out of pocket...?
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