Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Rationalization”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 289 records · Page 16Linked to original sources
PubMed1982

Trace elements status of fetuses from ewes fed a copper-deficient ration.

Tissue samples were taken from 130-day-old fetuses from ewes fed a synthetic diet low in copper (Cu), a Cu-supplemented synthetic diet, or a roughage diet adequate in Cu content. The fetal liver and kidney Cu concentrations were substantially lower when the dams were fed the Cu-deficient ration than when they were fed the Cu-supplemented ration or natural diet. Differences between dams' rations in Cu concentrations for the other 3 fetal tissues (spleen, heart, and lung) were small. Differences among groups in fetal tissue iron concentrations were not significant at the P greater than 0.05 level. Concerning zinc concentrations, there were significant interactions between dams' diets and fetal tissues, mainly attributable to differences between rations in liver, heart, and kidney zinc levels. For manganese, the difference among dams' rations and among fetal tissues were significant at the 1% level, but the interactions of ration x tissue were also significant. Heart and spleen manganese concentrations were substantially higher in the fetuses from dams given Cu-deficient diet than in fetuses from dams fed Cu-adequate diet.

Animals↗
PubMed1981

[Effect of various types of ration on the digestive processes of ewe lambs].

Two groups of lambs of the same age (from two weeks to one year), breed, and live weight were given various types of rations: I - a 'concentrate' group, fed concentrates, and II -a 'haylage' group, fed rations in which roughage prevailed. After the completion of one year of age duodenal anastomoses were effected in three animals of each group. Balance and physiologic experiments were carried out with the animals in each group, that were supplied with fistulae. In the first experiment each group was given a ration of the same structure as that given up to the age of one year. In the second experiment the rations of the two groups were exchanged. In the third experiment both groups obtained one and same ration of the optimal size and structure. It was found that the feeding of growing animals with a given type of ration led to the adaptation of the digestive system to such diet, with best utilization of the individual feedstuffs.

Adaptation, Physiological↗
PubMed1981

[Effect of different types of rations on the coefficients of digestibility in ewe lambs].

Two groups of lambs (aged 2 weeks to 12 months and equalized in terms of age, breed, and liveweight) were given rations, differing in type as follows: the first group obtained concentrates which predominated in the ration (a 'concentrate' group), and the second one obtained mainly roughage in the ration (a 'hay' group). After the completion of one year of age three animals of each group were surgically treated so as to form duodenal anastomoses. Then the fistulated animals were used in balance and physiologic experiments. In one experiment each group was given the same (in structure) ration up to the age of one year. In a second experiment the rations of the groups were interchanged. It was found that the total coefficients of digestibility of the feed stuffs depended on the ration type, and the coefficients of digestibility with the dry matter, organic matter, crude proteins and fats, and mineral matter proved higher in the group that was given mainly concentrates.

Aging↗
PubMed1978

[Evaluation of coffee pulp as a possible substitute for corn in poultry rations].

A study was conducted to determine the possibility of using coffee pulp as an ingredient of chick rations. Another objective of the study was to evaluate the biological effect of adding sodium metabisulfite on the nitritive value of the agricultural by-product. Fifteen day-old chicks were fed rations containing 10, 20 and 30% coffee pulp, untreated and treated with 1 and 2% solutions of sodium metabisulfite. After three weeks on these rations, the animals were switched to one containing 30% coffee pulp, for five weeks. Results of the first experimental period showed a negative effect of coffee pulp on weight gain, feed conversion and water consumption on a water intake/weight basis. Apparently, treatment of coffee pulp with a 2% solution of sodium metabisulfite improved the above parameters but without reaching those attained by the control ration. In the second part of the study, the groups fed 30% coffee pulp, with and without metabisulfite treatment, gained less weight and showed lower feed conversion efficiencies than the control group. An interesting fact was the absence of mortality even in those groups fed 30% coffee pulp in the first part of the study. From these data it is concluded that coffee pulp at levels of 10% can be used with no problem in chick rations. It is necessary, however, to carry out additional studies before recommending the use of this by-product in poultry rations.

Animal Nutritional Physiological Phenomena↗
PubMed1999

The cost of living: kidney dialysis, rationing and health economics in Britain, 1965-1996.

How important is research in shaping policy when a new life-saving medical technology becomes available, but happens to be very expensive? Taking the case of kidney dialysis, this paper argues that the emerging discipline of health economics had little influence relative to national differences in health service organization and cultures of expectation of provision. Paradoxically, the most effective covert rationing was achieved under the British NHS which ostensibly provides free care for all, while the uncentralised market system in the US gave way, on this issue, to almost universal state-subsidised provision. Under the British system, the most cost-effective options for renal care tended to flourish, but some patients were turned away. Physicians have been held responsible for complying with covert rationing: this paper suggests that early gearing towards socially-useful survival filtered back to selection at primary level, possibly continuing long after specialists wished to expand. Public outcry, though muted, reached parliament and caused minor shifts in policy; the main aim of the voluntary pressure campaign, to release more organs for transplant through 'opt-out', remained unrealised in the UK. Yet dialysis was targetted for expansion in the 1980s just at the point when health economists were presenting evidence for its low cost-effectiveness compared with other expensive interventions. According to the main strand of argument in this paper, comparisons with other countries and between regions were most influential in breaking the hold of covert rationing: policy making by embarrassment. However, in the 1990s, there are both theoretical discussions of explicit rationing, and open intiatives afoot to target dialysis for rationing.

Health Care Rationing↗
PubMed2002

"Primary" rationing of health services in ageing societies--a normative analysis.

While most of the debate on "rationing in health care" focusses on the distribution of scarce medical resources among competing needs, which we propose to call "secondary rationing," this paper is concerned with "primary rationing," i.e., the conscious decision by society to limit the amount of resources devoted to a collectively financed health care system. Based upon a number of transparent normative criteria, we analyze whether primary rationing should be performed and, if so, what type should be chosen (hard vs. soft, explicit vs. implicit). Finally we discuss whether age should be used as a criterion in any systematic attempt at primary rationing of health care.

Adult↗
PubMed2001

Who wants to know if their care is rationed? Views of citizens and service informants.

OBJECTIVE: To explore the views of citizens and service informants about whether they would want to know about any rationing of their own health care. DESIGN: In-depth interviews using a semistructured schedule. Data were analysed using the methods of constant comparison. SETTING AND PARTICIPANTS: Citizens and service informants. MAIN VARIABLES STUDIED: Issues around health care rationing were explored within the context of the United Kingdom health care system. RESULTS: The views of citizens and service informants were very similar in terms of whether they, personally, wanted to know about any rationing of their own care, with the vast majority wanting to be given this information. Informants were also similar in terms of their reasons for wanting to know about rationing: to be given a 'good explanation' to enable them to judge whether the decision made had been correct; and to enable them to change the decision if necessary, either through protest or payment. Many informants suggested that they would indeed be likely to react either by challenging the decision or by paying for care. CONCLUSIONS: The findings suggest that policies to be open with people about the rationing of care would be welcomed, but also indicate that if protest follows such openness, it may be difficult for the health service to cope with greater explicitness. Further research is needed among patient groups actually facing this situation.

Adult↗
PubMed1992

An ethical framework for rationing health care.

This paper proposes an ethical framework for rationing publicly-financed health care. We begin by classifying alternative rationing criteria according to their ethical basis. We then examine the ethical arguments for four rationing criteria. These alternatives include rationing high technology services, non-basic services, services to patients who receive the least medical benefit, and services that are not equally available to all. We submit that a just health care system will not limit basic health care to persons unable to pay for it. Furthermore, justice in health care requires limiting publicly-financed non-basic health care, striving for equality in access to basic health care, and relying on medical benefit to ration non-basic health care.

Beneficence↗
PubMed1995

Rationing in the NHS: the dance of the seven veils-in reverse.

The 1991 reforms of the National Health Service set up the expectation that rationing would in future be explicit instead of, as in the past, implicit. This has not happened. Research carried out at the University of Bath shows that very few health authorities are rationing by exclusion on the Oregon model. Instead, both central Government and health authorities are continuing to diffuse responsibility among the medical profession. This paper analyses the reasons why. Rationing by delay and dilution are more significant-as well as less visible-than rationing by exclusion. And it is the medical profession which controls the flow of patients through waiting lists and the way in which resources are used during treatment. Similarly, it is in the self-interest of both central Government and health authorities that their resource decisions should continue to be disguised behind the veils of clinical discretion. Despite pressures for greater transparency, Britain's opaque form of rationing may therefore survive.

Forecasting↗
PubMed2001

Balancing rationalities: gatekeeping in health care.

Physicians are increasingly confronted with the consequences of allocation policies. In several countries, physicians have been assigned a gatekeeper role for secondary health care. Many ethicists oppose this assignment for several reasons, concentrating on the harm the intrusion of societal arguments would inflict on doctor-patient relations. It is argued that these arguments rest on a distinction of spheres of values and of rationality, without taking into account the mixing of values and rationalities that takes place in everyday medical practice. If medical practice, then, does not follow a single, pure rationality, can it also incorporate the societal rationality of the gatekeeper role? Using a case from general practice, I try to show how physicians may integrate societal arguments into their practice in a morally acceptable way. A version of the model of reflective equilibrium and especially Beauchamp and Childress's safeguards, may be helpful both to analyse and teach such balancing of values and rationalities.

Anecdotes as Topic↗
PubMed2002

Rationing of expensive medical care in a transition country--nihil novum?

This article focuses on rationing of expensive medical care in the Czech Republic. It distinguishes between political and clinical decision levels and reviews the debate in the Western literature on explicit and implicit rules. The contemporary situation of the Czech health care system is considered from this perspective. Rationing reoccurred in the mid 90s after the shift in health care financing from fee-for-service to prospective budgets. The lack of explicit rules is obvious. Implicit forms of rationing, done by physicians at the clinical level prevail, implying uncontrolled power of the medical profession and lacking transparency for ethical considerations of equity to access. It seems to be acceptable for physicians to play the role of allocators, probably because of their experience with rationing during the socialist period. Traditional rationing stereotypes from the previous regime seem to persist despite the health care system transformation during the 90s.

Czech Republic↗
PubMed1995

Should health care be rationed by age?

Can rationing of health care by chronological age be justified on ethical grounds? The principles of equality, solidarity, liberty and efficiency are used as value premises in the discussion. Health care rationing by age is inconsistent with the principles of equality and liberty. But in some situations such rationing has support from the principles of solidarity and efficiency. The compromise suggested is that, as a rule, rationing by age should not be permitted, except in situations with intrinsic scarcity (as is the case with transplantation) and in situations with temporary extrinsic scarcity (as was the case with dialysis for a period of time). However, the main purpose is not to defend this position, but to identify and analyze the ethical conflicts such rationing gives rise to.

Age Factors↗
PubMed2005

"Saying no is no easy matter" a qualitative study of competing concerns in rationing decisions in general practice.

BACKGROUND: The general practitioner in Norway is expected to ensure equity and effectiveness through fair rationing. At the same time, due to recent reforms of the Norwegian health care sector, both the role of economic incentives and patient autonomy have been strengthened. Studies indicate that modern general practitioners, both in Norway and in other countries are uncomfortable with the gatekeeper role, but there is little knowledge about how general practitioners experience rationing in practice. METHODS: Through focus group interviews with Norwegian general practitioners, we explore physicians' attitudes toward factors of influence on medical decision making and how rationing dilemmas are experienced in everyday practice. RESULTS: Four major concerns appeared in the group discussions: The obligation to ration health care, professional autonomy, patient autonomy, and competition. A central finding was that the physicians find rationing difficult because saying no in face to face relations often is felt uncomfortable and in conflict with other important objectives for the general practitioner. CONCLUSION: It is important to understand the association between using economic incentives in the management of health care, increasing patient autonomy, and the willingness among physicians to contribute to efficient, fair and legitimate resource allocation.

Attitude of Health Personnel↗
PubMed2001

Cutting healthcare costs without rationing at the bedside: preserving the doctor-patient fiduciary relationship.

In his essay on bedside rationing, Peter Ubel argues that in an era of rising healthcare costs, it is time to relax the patient-centered ethic of physicians as unconditional patient advocates so they can individualize rationing decisions. This paper raises several concerns with the arguments and the examples he provides to make his case. First, he overlooks cost-effectiveness when making medical spending decisions. Second, his examples of wasteful, unproven and potentially harmful interventions call for physician education, not rationing, as he suggests. Third, informed patients can play a role in lowering costs through shared decision making. Fourth, individualized rationing decisions will worsen already pervasive disparities in medical care. The paper envisions the ideal cost-conscious physician as one who is knowledgeable about cost-effective practices, avoids unproven interventions whenever possible, and facilitates shared decision making through patient education. Such an individual would not, however, withhold interventions of proven benefit except when accommodating a patient's preferences for a particular therapy. The doctor and patient can only work together within the constraints of system-wide rationing if the fiduciary relationship is never violated.

Cost Savings↗
PubMed1997

Moral judgments in the rationing of health care resources: a comparative study of clinical health professionals.

Social workers, physicians, and nurses from a major urban teaching hospital were assessed and compared regarding their attitudes toward the rationing of health care. Responses to eighteen statements of considered moral judgments in the rationing of health care resources were analyzed in terms of levels of agreement with each. All three professional groups rejected rationing based on patient age and socioeconomic worth. However, social workers and physicians were more likely than nurses to consider such factors as cost-benefit ratios, quality of life, relative strength of a patient's moral claim, and scarcity of resources in rationing decisions. Study findings appear to portray social workers and physicians as being more utilitarian and nurses more egalitarian in rationing decisions. Implications for practice in a managed care environment are presented.

Adult↗
PubMed2002

Health care rationing affecting older persons: rejected in principle but implemented in fact.

Health care resources are finite and, therefore, need to be rationed among potential users. Over the past decade and a half in the United States, a variety of explicit, official rationing schemes have been proposed, including some in which chronological age would play a significant role. For ethical and political reasons, it is very unlikely that any age-based rationing schemes will be adopted explicitly and officially. However, various de facto forms of health care rationing are occurring at present. This article outlines the implications of payer behavior, physician practice patterns, the development of evidence-based clinical practice parameters or guidelines, and reliance on consumer choice of health plans as unofficial and generally unacknowledged mechanisms of health care rationing that may exert an important impact on the accessibility of health services for older persons.

Aged↗
PubMed1995

Rationing health care and the need for credible scarcity: why Americans can't say no.

With adequate cost containment unlikely in the foreseeable future, health care use will have to be curtailed, ideally with open and explicit criteria for equitably allocating resources or rationing. Yet, consensus on any such criteria appears remote because Americans cannot say no to health care. Americans may refuse to accept rationing for two reasons. The absence of any global limitation on health care resources may encourage patients to believe that health care resources are not scarce and do not need to be rationed. A belief in vitalism--that everyone is morally entitled to unlimited longevity and good health--may discourage setting limits on one's own care. Together, these characteristics may foster the belief that denials of health care services, especially by health insurers, are arbitrary or unfair refusals to pay for existing resources and not a necessary method of rationing scarce resources. If this hypothesis is true, Americans are unlikely to achieve consensus on any equitable allocation of health care unless they face an actual shortage (credible scarcity) of health care resources that makes it necessary to ration care.

Attitude to Health↗
PubMed2006

Healthcare rationing in Spain: framework, descriptive analysis and consequences.

This paper describes the main healthcare rationing policies implemented in Spain over the last 2 decades, and analyses the consequences of these policies on the healthcare system, patients, healthcare practitioners, the pharmaceutical industry and policymakers. The primary explicit healthcare rationing policies utilised in Spain include a catalogue that defines the healthcare rights of citizens. However, the existing system may lead to inequity between regions, and is not structured to direct resources towards the most cost-effective options. Health technology assessment requires further work before it can be utilised widely for the development of rationing strategies. Selective reimbursement of drugs and drug co-payments provide only short-term results and appear to have little long-term impact on expenditure. Implicit rationing instruments, especially waiting lists, have had a significant effect on healthcare quality and the welfare of citizens, and have contributed to keeping the Spanish healthcare budget under control. Newer regulations should integrate some form of economic evaluation within the policy-making processes associated with healthcare. Further research is needed to identify those efficient and equitable rationing instruments that are most likely to improve health interventions for an aging society that is increasingly demanding of health services.

Health Care Rationing↗