Funding criteria for common procedures: A postcode lottery in NHS plastic surgery

The bare necessities? A realist review of necessity argumentations used in health care coverage decisions

“…All decisions, which included primarily actual and a few hypothetical decisions, use certain physical characteristics, evidence of physical or psychosocial morbidity, reduced social capacity, or a combination thereof, to argue for necessity of coverage in certain cases. Decision makers thus set physical or psychological patient eligibility criteria on the morbidity experienced that need to be applied by a physician [84,[86][87][88][89][90][91][92][93][94][95][96][97][98][99][100]. Individual assessment providing evidence of morbidity here leads to a higher justifiability of surgery.…”

“…Individual assessment providing evidence of morbidity here leads to a higher justifiability of surgery. In this way, surgery is performed only on those patients that fall on the 'right' side of the line between cosmetic and non-cosmetic care [86,100], or outside a "range of normality" [84,[87][88][89]91,92,[95][96][97][100][101][102], so that care is only provided if medically necessary [94,103]. Some argue that cosmetic surgery should be covered only in case of societal functioning problems [87,89,95], which McClean argues to be affected only in some cases [92].…”

“…Argumentations for a hypothetical positive decision were offered primarily for treatment of port-wine stains, with medical complications and psychosocial morbidity explicated [92], also [89]. The (potential of a) 'postcode lottery' was brought up a number of times, to apparently argue in favour of coverage [89,95,97,98,100].…”

“…[28]. In addition, the UK has a high percentage of the Equity/Fairness/Justice argumentation type, which is primarily due to the concern and outrage about 'postcode rationing' [87,89,95,97,98,100].…”

Funding for Postbariatric Body-Contouring (Bariplastic) Surgery in England: A Postcode Lottery

“…Wraight et al, in 2007, showed a variation in guidelines across Trusts in the UK, amounting to a “postcode lottery” for patients seeking breast reduction [ 16 ]. More recent work by Henderson in 2009 [ 17 ] and Goodson et al in 2011 [ 18 ] has shown that there does exist a disparity between PCTs for plastic surgery procedures, despite national guidelines. This has also been demonstrated for in vitro fertilisation (IVF) treatment in a report in 2009 [ 19 ].…”