Using Computer Models to Ration Health Care?

We discussed the new computer model that supposedly can predict how much longer one has to live in the context of whether a patient should be told they have less than ten years.  But the NYT’s take on the same story raises another issue we only tangentially touched before; whether a computer program predicting how long a patient has to live could be put to pernicious heatlhcare rationing effect, similar to the “quality adjusted life year” (QALY) that was used by NICE to ration medicine in the UK.  From “Using Interactive Tools to Assess the Likelihood of Death:”

Now, researchers at the University of California, San Francisco, have identified 16 assessment scales with “moderate” to “very good” abilities to determine the likelihood of death within six months to five years in various older populations. Moreover, the authors have fashioned interactive tools of the most accurate and useful assessments. On Tuesday, the researchers published a review of these assessments in The Journal of the American Medical Association and posted the interactive versions at a new Web site called ePrognosis.org, the first time such tools have been assembled for physicians in a single online location.       

“We think a more frank discussion of prognosis in the elderly is sorely needed,” said Dr. Sei Lee, a geriatrician at U.C.S.F. and a co-author of the review. “Without it, decisions are made that are more likely to hurt patients than help them.” Dr. Lee and his colleagues cautioned that while the best assessments are reasonably accurate, there is insufficient data on whether using them improves patient care in clinical settings. The researchers stopped short of urging widespread use.

For now, perhaps. But wait until Obamacare bureaucrats grab ahold.

One doesn’t have to be paranoid to see where this can lead. Under QALY systems, roughly stated, a cost benefit analysis is done to justify providing or withholding an intervention based on the time it is expected to give a patient, adjusted for the quality of life during that time.  Thus, the same intervention that would give me, say, five years of life, might be only worth two years of QALYs if the time would likely include my being disabled.  And something worth five QALYs might be paid for but not something worth two.  The same type of thing could easily be fashioned with this computer model—and don’t think some people aren’t thinking about doing just that.

Do we want people to have information to properly give informed consent and refusal to potential interventions?  Absolutely. Do we want doctors to not offer particular efficacious interventions—or the government/private insurance company refusing to pay for them—because the computer model opined that the patient has a 78% chance of, say, living less than three years?  I think not. Could this kind of information to be used to justify medical discrimination?  You betcha! Indeed, I fear some want to do just that—particularly given the bureaucratic cost saving impetus behind Obamacare’s many cost/benefit panels.

Could this become a hope killer?  You betcha again!  We should tread with very great care here.