Ratio of waist circumference to height is strong predictor of intra-abdominal fat: Fig 1

Abstract

necessary.A national waiting list policy that guarantees access according to agreed criteria, rather than simply guaranteeing maximum wait- ing times, could facilitate contracts between pur- chasers and providers on the basis of agreed criteria for the prioritisation of waiting lists.Points could be assigned to patients by consultants to reflect, for example, current health status, assessed using the EuroQoL or SF36 health status measures; expected gain in quality of adjusted life years (QALY)3 from treatment; or some combination of clinical factors such as rate of deterioration and social factors reflecting dysfunction in usual activities.This is being pursued by New Zealand's Health Commission4 and in the United Kingdom is being piloted at Salisbury District Hospital.5Points schemes could help establish thresholds for entry on to elective waiting lists and help standardise general practitioners' referral prac- tice for routine procedures.If rationing in the NHS is inevitable, waiting list points schemes could help to ensure that patients with similar need, somehow reflected by their points allocation, could be assured of simi- lar access to treatment, regardless of clinical specialty, geographical location, or general practitioner's status.Points schemes could provide a redefinition of the principle on which the NHS was founded within the constraints of resource limitation.