Tuesday, November 18, 2008

Blood culture to change, but not at any price

Russell McGowan recently attended a national seminar, run by the National Blood Authority in Sydney. He has written the following post on a few issues that emerged.

I learnt that blood is not actually free, but comes at a price. That price can be up to $1000 per unit of fresh red cells transfused, and more like $2500 per patient assisted. In fact, the cost of blood accounts for as much as 5% of all health expenditure.Now I have been a frequent user of blood and blood products in the past – at one stage receiving as many as six units a month as my enlarging spleen started to consume all the blood my bone marrow could produce.

Subsequently, I became a heavy user of IVIG, a fractionated derivative of blood plasma, to boost my immune system following my bone marrow transplant. As a result I have followed the evolution of blood service arrangements in this country with some interest. The latest development is that private hospitals in NSW are to be charged for the blood that they use. (see article from The Age, 15 November 2008).

This will be seen by some as exploitation of donors (including my daughters) who give blood freely to help the health system do its job. Fortunately I won’t have to refund the health system for all the blood I have received over the years, but what will it mean for other consumers?Why would a State Government break ranks with its counterparts and start charging for blood? The answer is quite simple – we don’t value what we don’t have to pay for.

Blood is often used inappropriately in health care when other therapies would be more cost effective and probably would produce better outcomes for consumers. So at a time when threats to the blood supply are looming larger than ever before, it makes a lot of sense to set some price signals to help control use of a scarce resource.Surgeons can operate successfully without resorting to blood transfusions – they do it already for Jehova’s Witness patients. Haematologists can learn not to resort to transfusions for anaemia when mere infusion of intravenous iron can achieve an equivalent or better effect.

In the ACT, the TCH blood team has recently attacked wastage of blood in operating theatres where excess units are provided for surgery just in case they are needed, but are left lying around at room temperature for too long in the process and then need to be discarded rather than being used elsewhere. A good start to dealing with an insidious inefficiency.

I am more than happy to discuss these issues with any readers interested in them. In addition there is an opportunity for consumer input to a professional and community forum being conducted by the National Blood Authority here in Canberra in early December.It is to be hoped that blood culture can be changed in the health system to ensure better outcomes for consumers and that politics generated the NSW Government action will not railroad reforms into a dead end siding.

Russell McGowan

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