1. In austere financial times, which procedures should be rationed and who should decide? Jason Yuen Final year medical student – University of Oxford Professor Harold Ellis Medical Student Prize for Surgery 23 rd November 2012

4. 1) Tough financial conditions 2) Ageing population 3) New, expensive treatments

5. Economic Clinical Ethical

6. Clinical aspect Risks of surgery Benefits of surgery

7. QALY?

8. Also consider – Local expertise – Alternatives

9. Ethics – Still meet the needs of everyone? – No but we need to consider how to distribute the resources fairly and based on clinical need, not ability to pay

11. Costs?

14. Take home message Rationing is inevitable In order to prioritise procedures, factors to consider – clinical, economic, ethical – Problems in balancing these – Systematic and fair approach The stakeholders

15. 'You need an urgent operation. But not to worry, I'll make sure you're on my list.' Any questions?