> And how will people understand that some cancers should be convered while others shouldn't?
I don't understand the question. All cancers are covered. If a cancer is treatable then it is treated. If there's no hope than palliative care is provided. If it's in the quite wide margin then the patient and the doctor talk about current best practice, and decide based on what the patient wants.
If you're asking about how the people paying the bills decide what treatments can be funded and what treatments should not be funded, well, you develop a measure. That measure is something like "years of quality life" - Quality of Life Years is used in bit of English planning.
You have an independent body assessing evidence of effectiveness, vs cost. If something provides X QoLYs it gets permission for funding; if it doesn't the patient can fund it themselves.[1]
They then publish their documentation, and it gets reviewed every few years.
That's a transparent process, allowing people to review and challenge the choices made.
This can lead to some odd decisions. Treatment for some forms of age-related macular degeneration used to be limited to one eye, because being blinded is bad, but being blinded in one eye is not as bad. That decision was later changed.
Alongside that you tell people to stop smoking, and you offer them free smoking cessation services; you have strong H&S COSHH laws, and you enforce them; you educate about the dangers of too much sun[2]; etc etc.
[1] The UK had an unfortunate situation where drug companies were creating cancer treatment drugs that would provide maybe 30 days of extra life at a cost of tens of thousand of pounds. They then set up and funded patient advocacy groups who would call for the drugs to be funded on the NHS. Providing information to those groups was an effective way to bypass the strict laws against marketing to the public. The weird choice the government at the time made was to change a law so that if someone wanted to "top up" their treatment with one of these expensive but useless meds that person would have to fund all their treatment, not just the cost of those extra meds.
[2] Vitamin D is very important, and helps avoid some cancers. You only need a bit of bright sunshine (or better diet) to get it - sun bathing for hours everyday with no sun-screen is too much.
I can't comment of the UK system, I haven't had any experience with it (theoretical experience is not the same as the actual experience)
QALYs and DALYs have a potential - they are interesting tools to separate covered cancer from uncovered cancers, but I would fear political abuse and biased measurements - just like your [1] example.
The PBS (an independent government organization, which is walled off from political lobbying) will subsidize drugs, but only ones which are worth it (as decided by expert panels). They act as a monopoly buyer, forcing monopoly sellers (the drug companies) to offer a more reasonable deal. If the drug is too expensive, the PBS won't subsidize it, and the drug company can lower the price (to get PBS subsidies) or face drastically lower sales.
I don't understand the question. All cancers are covered. If a cancer is treatable then it is treated. If there's no hope than palliative care is provided. If it's in the quite wide margin then the patient and the doctor talk about current best practice, and decide based on what the patient wants.
If you're asking about how the people paying the bills decide what treatments can be funded and what treatments should not be funded, well, you develop a measure. That measure is something like "years of quality life" - Quality of Life Years is used in bit of English planning.
You have an independent body assessing evidence of effectiveness, vs cost. If something provides X QoLYs it gets permission for funding; if it doesn't the patient can fund it themselves.[1]
They then publish their documentation, and it gets reviewed every few years.
That's a transparent process, allowing people to review and challenge the choices made.
This can lead to some odd decisions. Treatment for some forms of age-related macular degeneration used to be limited to one eye, because being blinded is bad, but being blinded in one eye is not as bad. That decision was later changed.
Alongside that you tell people to stop smoking, and you offer them free smoking cessation services; you have strong H&S COSHH laws, and you enforce them; you educate about the dangers of too much sun[2]; etc etc.
[1] The UK had an unfortunate situation where drug companies were creating cancer treatment drugs that would provide maybe 30 days of extra life at a cost of tens of thousand of pounds. They then set up and funded patient advocacy groups who would call for the drugs to be funded on the NHS. Providing information to those groups was an effective way to bypass the strict laws against marketing to the public. The weird choice the government at the time made was to change a law so that if someone wanted to "top up" their treatment with one of these expensive but useless meds that person would have to fund all their treatment, not just the cost of those extra meds.
[2] Vitamin D is very important, and helps avoid some cancers. You only need a bit of bright sunshine (or better diet) to get it - sun bathing for hours everyday with no sun-screen is too much.