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PubMed1990

The status of expectancy-arousal theory: comparative credibility of systematic desensitization and rational-emotive therapy in the treatment of anxiety about study.

96 university students were asked to imagine that they were suffering from study anxiety to the point of wishing to receive help with the problem. They were then asked to read a booklet detailing either (a) the rationale for systematic desensitization or Rational-Emotive Therapy and (b) told that counselling lasted for 5 or 15 weeks. They then assessed the credibility of the therapy using Borkovec's credibility rating method. Meta-analysis has shown that systematic desensitization has superior outcomes when compared to other treatments, but this could be attributed to the different expectations of benefit that the therapies arouse. This notion has been called the expectancy-arousal hypothesis. Results from the present experiment did not support Shapiro's 1981 findings that systematic desensitization was more credible than Rational-Emotive Therapy, which disconfirms the expectancy-arousal hypothesis, but the basis for this remains unclear.

Adult↗
PubMed1989

Rationing health care--should it be done?

1. The utilitarian view supports allocation of goods to meet the needs of the greatest number of people; Lamm contends that the only just rationing would be according to age. 2. Some theorists assume that all individuals will live relatively healthily until the end of their natural lifespan; they do not distinguish between therapeutic medications and those that alleviate suffering. 3. According to intergenerational arguments, children should receive priority in funding, with the elderly at the lower end of the scale. 4. The Advisory Panel of the Office of Technology Assessment recommends rationing based on prognosis and quality of life; however, good prognostic skills are lacking and there is no consensus on quality of life.

Aged↗
PubMed2004

Rational emotive behavior therapy: disputing irrational philosophies.

This article provides an overview of the concepts and techniques of rational emotive behavior therapy to distinguish it from cognitive-behavioral therapy. Rational emotive behavior therapy proposes that psychological disturbance is largely created and maintained through irrational philosophies consisting of internal absolutistic demands. This therapy strives to produce sustained and profound cognitive, emotive, and behavioral change through active, vigorous disputation of underlying irrational philosophies.

Adaptation, Psychological↗
PubMed2001

Evidence for age-based rationing in a Swiss university hospital.

AIM: To test the hypothesis that rationing of medical management mainly based on age exists in our health care system today. METHODS: We studied 303 consecutive patients hospitalised for acute coronary syndrome (ACS) and 163 consecutive patients hospitalised with congestive heart failure (CHF). They were divided into two age groups; patients aged less than 75 years and those equal to or older than 75 years. RESULTS: Our main findings were a significant underuse of stress tests (p < 0.001) and coronary angiography (p < 0.0001) in elderly patients with ACS and a significant underuse of echocardiography (p < 0.0001) in patients with CHF of the same age group. In patients with ACS, there was also a trend towards underuse of statins in elderly patients with hypercholesterolaemia. In addition, we noted that the use of beta-blockers in ACS and of ACE inhibitors in CHF was better than in previous published studies but that many patients were still not treated according to evidence based medicine. CONCLUSION: The lower rates of diagnostic tests performed and the lower statin use observed in elderly patients suggest "hidden" rationing of health care in elderly patients.

Age Factors↗
PubMed1991

Providers give rationing substantial support.

Rationing healthcare services to help control soaring medical costs gets more support from providers than from consumers or employers, a recent survey of consumers, business executives and healthcare professionals shows. When asked whether healthcare should be rationed, 57% of the hospital chief executive officers and 46% of the physicians said "yes". But only 29% of the employers and 16% of the consumers agreed.

Attitude of Health Personnel↗
PubMed1999

[The right to treatment: priority or rationing?].

The distance that exists between what medicine can offer and the resources available in order to guarantee equal rights in health care continues to expand. It is therefore necessary to begin facing some difficult choices. These choices must include both the rationing of cost and fair distribution among its receivers. In what seems a step in the right direction, a particular change has been happening that points towards the decline of the importance of "monetary fundamentalism". The Amsterdam Treaty has placed the following principles on the task list of the European Union: 1) health (not just health care) must be a much higher priority in public policy; 2) the main factors of health care inequality are social and cultural (poverty, public health considered a simple element of the economy, medicine reduced to therapeutic technology); 3) health care resources must not be just a simple financial measure; 4) the choices to be made in order to achieve equal distribution of these resources should regard all citizens and not just experts. If these principles are applied in a practical manner, an alternative to rationing health care can primarily, even if not completely, be formulated.

Adult↗
PubMed1999

Rationing: how and who?

Rationing health services, in the sense of denying care deemed of positive benefit by at least some health system actors, is a problem that politicians would like to avoid. Health policy analysis has offered a number of approaches, such as global budgeting, technology assessment, managed competition, legal recourse and public participation as palliatives for this difficult problem. Each of these approaches on its own falls short, but no country has yet designed a process for explicit rationing. Israel, in the context of its recent health reform, has gone as far as any country in this direction. However, significant political leadership will be required to frame the public discussion of these difficult issues.

Cost Control↗
PubMed1999

Fairness and rationing implications of medical necessity decisions.

When healthcare coverage entails medical necessity review, patients, providers, payers, and government agencies must confront issues of fairness and rationing. To explore the ethical ramifications of medical necessity decisions, we provide 2 illustrative case. In the first case, we discuss the implications of rule-based rationing and in the second we consider the influence of a medical group's internal review council on decisions of medical necessity. Both case examples illustrate why there are no agreed-on rules for setting a threshold for approving or denying care based on medical necessity and suggest that more complex medical cases require a more complex review process.

Decision Making↗
PubMed2002

[Are health care facilities in Cameroon compatible with rational management of emergency patients?].

The aim of this month-long cross sectional study was to evaluate the preparedness of health care institutions in Cameroon to provide rational management of emergency patients. During January 2002 a survey was carried out to list all health care institutions offering emergency care services and to determine their other departments and available equipment and staff. A total of 144 institutions with emergency care facilities were found including 12 central reference hospitals and 123 district hospitals equipped to provide primary emergency care. In relation to a population of 15 million inhabitants, the ratio was one reference hospital for 104180 inhabitants and one district hospital for 100,000 inhabitants. None of the services involved in emergency management had facilities for emergency treatment on an outpatient basis. Regarding hospital-based services, an emergency ward was available at the 12 central reference hospitals for a ratio of one ward for 1,250,000 inhabitants. This ratio was 10 times higher than in France in 1994. Almost all major equipment and trained personnel for emergency care medicine were concentrated at the central reference hospitals but these resources were insufficient to organize round-the-clock services except at a single site. The findings of this survey indicate that the distribution of health care facilities in Cameroon was relatively adequate in relation to population density but that equipment and human resources were still insufficient to provide rational management of emergency patients.

Cameroon↗
PubMed2002

Should rationing of health care be explicit?

The aim of this paper is to discuss whether medical professionals should inform patients that there may be drugs or procedures that would benefit them., but which the National Health Service cannot afford to provide. The main body of the paper examines the argument put forward by Professor David Hunter who suggests that rationing of health care should be implicit. I will argue that his arguments are unconvincing. Some of the reasons that Coast and Mechanic give support to implicit rationing of health care are looked at briefly and similarly found to be wanting. In our present culture openness is encouraged from doctors. It is also acknowledged by the medical profession that patients' autonomy should be respected. The importance of autonomy is emphasised in the teaching of our medical students. My submission will be that it is difficult to see how patients' autonomy can properly be exercised unless they are told that treatment is being refused to them that might help their condition.

Decision Making↗
PubMed2003

Medical rationing: the implicit result of Leadership by Example.

The Institute of Medicine (IOM) has released the latest publication in its campaign to curtail medical error: Leadership by Example: Coordinating Government Roles in Improving Health Care Quality. In this publication, the IOM recommends that the government utilize its position as the country's largest purchaser of healthcare to institute unified performance standards, create appropriate incentives to improve quality of care, and develop a system to disseminate provider-specific quality information to the public. The author examines these recommendations and the contents of IOM's prior publications and concludes that necessary predicates of IOM's vision are rationing of care and a two-tiered system of healthcare. Thus, if the IOM's recommendations are carried out, the author envisions a healthcare system in which truly state-of-the-art care can only be purchased out of pocket. He concludes that, although Leadership by Example is a rational plan to address escalating healthcare costs, it is unclear both whether the American public would support it if the IOM were explicit about its ultimate impact, and whether the recommendations, in the long run, will prove to be a good thing.

Delivery of Health Care↗
PubMed2005

Ethical principles and the rationing of health care: a qualitative study in general practice.

BACKGROUND: Researching sensitive topics, such as the rationing of treatments and denial of care, raises a number of ethical and methodological problems. AIM: To describe the methods and findings from a number of focus group discussions that examined how GPs apply ethical principles when allocating scarce resources. DESIGN OF STUDY: A small-scale qualitative study involving purposive sampling, semi-structured interviews and focus groups. SETTING: Twenty-four GPs from two contrasting areas of London: one relatively affluent and one relatively deprived. METHOD: Initial interviews asked GPs to identify key resource allocation issues. The interviews were transcribed and themes were identified. A number of case studies, each illustrative of an ethical issue related to rationing, were written up in the form of vignettes. In focus group discussions, GPs were given a number of these vignettes to debate. RESULTS: With respect to the ethical basis for decision making, the findings from this part of the study emphasised the role of social and psychological factors, the influence of the quality of the relationship between GPs and patients and confusion among GPs about their role in decision making. CONCLUSION: The use of vignettes developed from prior interviews with GPs creates a non-threatening environment to discuss sensitive or controversial issues. The acceptance by GPs of general moral principles does not entail clarity of coherence of the application of these principles in practice.

Adult↗
PubMed1995

Programming for family care of elderly dependents: mandates, incentives, and service rationing.

In response to a demographic imperative, many countries have established policies to increase family involvement in the care of their dependent elderly relatives. Reflecting fiscal constraints and cultural norms, these policies are often designed to place the burden of care on family rather than government. This article offers a survey and critique of three approaches to increasing family care of elderly people: filial support legislation, incentives for family caregivers, and service rationing provisions. Drawing in part on the results of a survey with respondents from 33 countries, it concludes that policies that require or encourage relatives to provide care may have adverse consequences for elderly people and their families. Human services advocates should support policies and interventions that provide universal access to a continuum of care alternatives that facilitate rational health care decision making by families and that empower and sustain family members who choose to care for elderly relatives.

Aged↗
PubMedDate not supplied

Rationales for rationing health care in the NHS.

Rationing of health-care resources has moved from being a theoretical possibility to becoming a practical reality, a move that has been made more explicit since the introduction of a market-oriented approach to the management of the health service. The following two papers provide an introduction to the debate surrounding health-care rationing and make some suggestions on how the subject can be placed under more explicit democratic controls.

Delivery of Health Care↗
PubMed1995

Should second eye cataract surgery be rationed?

To conserve limited resources, healthcare purchasers are questioning whether they should ration second eye cataract surgery after successful unilateral extraction. The effect this would have on overall cataract workload is unknown. The clinical indications for performing second eye cataract extraction were recorded from the medical notes of a random group of patients undergoing second eye surgery over a 1 year period. Twenty-six per cent of all cataract operations were on second eyes and, of these, 21.5% of operations were on patients with coexistent ocular pathology, requiring clear optical media for disease monitoring, and 18.4% were on patients who had failed to achieve a satisfactory result after unilateral cataract surgery (visual acuity 6/18 or worse). Another 43.6% had severe binocular visual disability due to their remaining cataract. Only 4.4% of all cataract operations performed during the study period were on second eyes of patients with no other ocular pathology who had had successful unilateral surgery and had only mild symptoms from their remaining cataract (visual acuity 6/12 or better in second eye). Therefore, the overall savings made by rationing second eye cataract surgery to those patients who have only mild visual disability would be slight. If the proportion of cataract operations performed as daycases under local anaesthetic were increased, sufficient resources would be released to enable all patients to achieve maximum binocular visual rehabilitation.

Aged↗
PubMed1997

Group therapy for anxiety disorders using rational emotive behaviour therapy.

This paper reports a pilot study designed to investigate Rational Emotive Behaviour Therapy in the group treatment of selected clients suffering from anxiety disorders. A convenience sample of 17 clients who completed the treatment programme was selected for the study. Biographical information was sought and data were collected on subject anxiety and depression. Intervention was targeted at identifying and correcting irrational beliefs via the application of a range of Rational Emotive Behaviour Therapy techniques. Pre- and postintervention data were analysed by two-tailed t-tests for paired samples and found to be significant at P < 0.001. The results suggest that the treatment approach was successful in modifying irrational beliefs and anxiety.

Adult↗
PubMedDate not supplied

Evidence-based medicine between explicit rationing, medical deontology and rights of patients.

Today a "just" health policy is balanced between the problem of the allocation of scarce resources and the priority setting of services, care and cures. Despite technologies and molecular medicine, with their tendency to reach absolute prediction of disease or absence of disease and to cure with predicted efficacy, a large portion of the public refuse the results of experimental procedures and prefer to place trust in so-called alternative medicine or in drugs which are not in the official guide-lines following the principles of evidence-based medicine according to DL Sackett. Juridical problems arise between the rights of free choice of cure and social dimension of Governmental care programs, which include the maximum of benefits (i.e. effective therapies) for a pre-fixed total budget. An explicit rationing only on budgetary bases without rationalisation of medical procedures reduces the rights to care of citizens-patients. Thus, an explicit rationing-rationalisation seems to be the only procedure compatible with the interest of patients in a social security system allocating "scarce" resources.

Budgets↗