July 23, 2009

NHS: prescriptions AND sick leave for everyone

Pharmacy Rx symbolImage via Wikipedia
The filter blog proides some interesting reading regarding the latest NHS decision to provide online (web/mobile) flu symptoms assessment and prescription generation service (available here, only UK residents can try it out unless risking prosecution:).
'The filter' blog looks at it mostly from a political perspective on incentives, but what catches my eye is also the perspective of perverse empowerment of the patient/user. Generally, patient empowerment is regarded as good as it often reduces the workload for various health care professionals. The general idea of empowerment in my opinion is the possibility for the user to monitor, trigger and actively participate in various health care services related to himself. Setting the rules of the triggering part of empowerment is tricky however - and I suspect this case will demonstrate how it should not be handled.
The reason most of clinical decisions are being made by clinicians is that in public health care there is always the axiomic misalignment in the 'provider-payer-consumer' relationship and there are always limitations in available funding. That's why gatekeeper systems and various participation models have been put into place - to reduce the unnecessary utilization of resources.
I use two assumptions in my opinion. The first is that the drugs received on the basis of prescription are free of surcharges (if otherwise there is a minor disincentive put in place) and the other is that the current state of the system is not in 'pandemic emergency' mode.
With these two assumptions in mind it looks to me that this case of on-line prescription service does not include an objective evaluation/measurement of symptoms & signs (either by health care professional or a valid on-line assessment which is difficult to imagine in this case) and as said bypasses all sensible methods of demand regulation.
To avoid abuse and waste of resources the system should be modified as to include an objective assessment that the user can not influence. Otherwise it is just a bad example of using eHealth services.

Update 04/09/09
I have met a colleague from UK who told me that the above site actually enables you to get a week-long sick leave besides the anti-viral drug. All only on the basis of the user choosing a single symptom like 'increased body temperature'. Could hardly believe it. This way incredible incentives have been put in place for people to simulate symptoms. I wonder what the possible outcome of a study using this data would/will show and whether someone is about to use the (skewed) results for adjusting health care policy. Discussed it with Rade Iljaz MD and we guess this will turn out like a prime example of eHealth gone bad.
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