## Friday, 2 May 2014

### On demand (but on a very serious topic)

My friend Virgilio has posted this on his Facebook page and invited me to comment. It is an article by a Spanish cardiologist that tells the story of a patient who has suffered a second stroke in a short amount of time $-$ as it turns out, the medication he was supposed to be taking was far too expensive for him, so he stopped the treatment, which presumably led to his second stroke.

Of course the individual story of a single, unemployed patient who cannot afford treatment is tragic. And of course, as I understand it, the general situation in Spain is not OK at the moment and this is likely to not be an isolated case, alas.

But I still think that the whole rationale of optimizing health resources allocation so that the overall population, on average, benefit from them, makes sense. Of course, how decisions (eg about pricing) are actually made, it's another matter and I'm not too familiar with the details of the Spanish system to comment on that.

Also, of course as I said that one story is tragic. But reporting bias may be present here: can we discount the possibility that many other cases do benefit from the fact that some form of prioritisation is made? For example, public money is probably saved from not giving treatments for other disease on the public health service, This means that (OK: probably not enough money, but at least some) money can be allocated on this area.