Economic Aspects of Neurosurgery
Critics of modern medicine who suspect that some of its activities do more harm than good, and that even avowed benefits may not be worth the cost, usually focus on various types of high technology medicine1. Surgery is both the oldest and the most widely practised example of a potentially hazardous and often expensive technological intervention offered to patients to improve their prospects of a good outcome. Within surgery some procedures and specialties are supposed more often than others to be of limited benefit or unusually costly. Examples include surgery for major congenital malformations in infancy and for advanced cancer, transplantation of heart, liver or lung, and the specialties of plastic surgery and neurosurgery. Debate about the ethics and economics of high technology medicine is now on the agenda in all westernised countries. This is because it is increasingly realized that rationing of health care is inevitable in even the most affluent societies. As a result, equity in the distribution of health care resources is recognized as an important principle of medical ethics2. Two other principles, non-maleficence (not doing harm to patients) and respecting patient autonomy, indicate that the use of some technologies is sometimes inappropriate even when resources are not an issue. We consider here the contribution that economic principles can make to this debate, dealing first with surgery in general and then with neurosurgery, for which some recent studies provide practical examples.
KeywordsHead Injury Subarachnoid Haemorrhage Severe Disability Economic Aspect Malignant Brain Tumour
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