C
In a way it's the same thing. Individual insurers or HMOs in the US make a decision about whether they will fund pumps, just like the NHS does. They're not obliged to do it. Like NICE in the UK, the insurers make a decision about whether the economics are justified. I guess one difference is that if the economics aren't justified at current premiums, they can raise premiums - everyone's premiums - to make it viable. The equivalent in the UK would be increasing the NHS budget by increasing taxation or public borrowing (or cutting other budgets). Much more difficult to do.Don't forget that in the USA they are covered by health insurance rather than the NHS so I guess if someone wanted a pump and their insurance covered it, they have greater access to them.