Total healthcare budget: assigning priority and level of asset allocation to the diagnosis and management of urologic diseases.

During the past decade increasing concern has developed as to how money should best be allocated in the healthcare sector and to the different disciplines within health care. In the Western world, healthcare budgets increase dramatically each year, even during periods of economic recession. There are many reasons explaining this evolution, but publicly funded healthcare systems, as in the United Kingdom, appear to control their growth more effectively than the private systems as, for instance, in the United States. The bulk of the increase in healthcare expenditure happens to be attributed to elderly people who are becoming high consumers of healthcare facilities. There are, however, two important ways to tackle the problem: one is based on free market regulation systems, introducing diagnosis related groups and resource based relative value scales, as in the United States. The other starts from evaluating the needs and the demands of the population and, based on these results, tries to build up an appropriate healthcare system, as in The Netherlands. In the realm of urology where most of the workload is concentrated around older patients, one can foresee difficulties concerning budget allocation. New medical treatments are introduced, demanding new management skills of the urologist. This should involve new ways of evaluating the benefits of the interventions. Quality of life measurements seem to be crucial for the future where, for cost-effectiveness reasons, more care than cure could be the new function of the urologist.