Limiting access to allogeneic bone marrow transplantation in five European countries: what can we learn about implicit rationing?
BACKGROUND
Allogeneic bone marrow transplantation is a complex procedure exemplifying a class of new and emerging treatment modalities involving advanced medical technologies with high costs.


OBJECTIVE
To collect available data on volume of allogeneic bone marrow transplantation in five European countries for the period 1990-1994. To assess the opinion of selected physicians on whether they felt that patients that would have benefited from a transplant actually received a transplant in the same period. To assess their opinion on possible reasons for limited access.


METHODS
Literature review and mailed self-administered questionnaire to the responsible physician at 76 transplant centres in Denmark, Germany, The Netherlands, Norway, and the UK.


RESULTS
Substantial geographical differences in transplantation rates between the five countries studied. For adult patients 62.5% of the respondents felt that there was limited access to allogeneic bone marrow transplantation in the period. For children, the corresponding figure was 37.5%. The reasons for limited access cited most frequently were scarcity of facilities or transplant beds, scarcity of donors, and inadequate referral practices.
Norheim
O F
OF
Department of Public Health and Primary Health Care, University of Bergen, Uriksdal 8c, 5009, Bergen, Norway. ole.norheim@isf.uib.no
D000328:Adult; D016026:Bone Marrow Transplantation / Q000191:economics / Q000706:statistics & numerical data*; D002648:Child; D003718:Denmark; D005858:Germany; D015276:Health Care Rationing / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D009426:Netherlands; D009664:Norway; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014184:Transplantation, Homologous / Q000706:statistics & numerical data; D006113:United Kingdom