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At least 19 recordsLinked to original sources
PubMed2001

A defense of visible health care rationing.

Health care rationing, when defined as resource allocation that makes use of a power relationship, is inescapable in every health care system. Central to this paper is the question: Is visible (publicized and centralized) health care rationing a requirement of justice or an affront to public morality? Inasmuch as health care is a public good, it is argued that health care resources should be visibly rationed in order to satisfy prevailing notions of procedural justice.

Community Participation↗
PubMed1994

Just caring: health reform and health care rationing.

Health reform must include health care rationing, both for reasons of fairness and efficiency. Few politicians are willing to accept this claim, including the Clinton Administration. Brown and others have argued that enormous waste and inefficiency must be wrung out of our health care system before morally problematic cost constraining options, such as rationing, can be justifiably adopted. However, I argue that most of the policies and practices that would diminish waste and inefficiency include implicit (and therefore morally problematic) rationing. Critics of rationing see as its most morally and psychologically troubling feature that an identified individual is denied potentially beneficial care. That psychic anguish may not be eliminable, and perhaps ought not be eliminated. But if rationing protocols are fairly adopted through a process of free and informed rational democratic deliberation to which all have access, the moral objections are largely overcome. Such a process is possible only if implicit rationing is recognized and rejected.

Advisory Committees↗
PubMed1993

Desperately seeking solutions: rationing dilemmas in health care.

Rationing health care is high on the policy agenda in many countries as the demand for care apparently outstrips supply. There are calls for the public to become more actively involved in determining priorities along the lines of the Oregon experiment in the United States. In Britain rationing has always been a feature of the National Health Service (NHS) although it has become implicit rather than explicit. The NHS reforms, principally the purchaser-provider separation, is making rationing much more explicit. The paper reviews the debate in Britain and concludes that there are no quick fixes or simple panaceas to a complex issue. It questions the extent to which the public can or should be involved in deciding who should or who should not get treated and argues that doctors have a central role to play in finding a better way of allocating resources effectively.

Community Participation↗
PubMed2004

Rationing health care in the welfare state: three policies.

Three policies of health care rationing are discussed. The premise underlying their analysis is that all welfare systems must ration health care. This raises the question as to how the problem ought best to be resolved. But before thinking about normatively appealing answers it might be helpful to study how the problem is dealt with in the real world. For such a study brings to light several advantages and drawbacks of various rationing schemes which would be hard to consider in the abstract alone, but whose knowledge may be highly relevant for any designation of adequate solutions.

Delivery of Health Care↗
PubMed1995

Rationing health care: from needs to markets? The politics of destruction: rationing in the UK health care market.

Rationing health care is not new. As governments world wide struggle to contain the costs of health care, health policy analysts debate how rationing should be done. However, they too often neglect how the mechanisms for funding and allocating health care resources are themselves vehicles for rationing treatment. In the UK, where health care rationing debates currently abound, there has been no formal evaluation of the role of the market in allocating scarce health care resources. The market in health care has increased administration, fragmented services, eroded local accountability, and decreased choice. This fragmentation, and the associated competition between purchasers and providers, means that resource allocation can no longer be monitored and evaluated in a national context. The loss of a population focus has left a vacuum in planning. Services cannot be planned rationally, and so are not able consistently to avoid duplication or to respond cogently to estimates of need. The loss of accountability means that decisions about the allocation of health care resources are no longer open to scrutiny by local people. Increasingly, especially in social and long term care the cost of care is being transferred to the individual. The new mechanisms for resource allocation are distributing resources unfairly: away from the poor, the sick and the elderly. The great myth of the market is that it has enabled decision-making to become explicit. This is not the case. To make health care resource allocation appear rational and acceptable to the public, health authorities have resorted to exercises in consumer consultation, and value laden guidelines where clinical cloaks are used to disguise political decisions on funding. In the UK, until the true role of the internal market is acknowledged, myths and subterfuge will conceal the winners and losers in the new system of rationing health care.

Decision Making, Organizational↗
PubMed1992

Symbols, rationality, and justice: rationing health care.

Proposals to ration health care in the United States meet a number of objections, symbolic and literal. Nonetheless, an acceptance of the idea of rationing is a necessary first step toward universal health insurance. It must be understood that universal health care requires an acceptance of rationing, and that such an acceptance must precede enactment of a program, if it is to be economically sound and politically feasible. Commentators have argued that reform of the health care system should come before any effort to ration. On the contrary, rationing and reform cannot be separated. The former is the key to the latter, just as rationing is the key to universal health insurance.

Health Care Rationing↗
PubMed1993

Rationing health care. Impact on critical care.

Critical care practitioners are faced with ethical dilemmas every day. The increasing costs of health care coupled with the scarcity of resources, including critical care nurses, have created yet another ethical dilemma--rationing of health care. Rationing of critical care is occurring today and current conditions indicate that these decisions will become an increasing issue in the delivery of critical care services. This article identifies some of the ethical issues associated with the rationing of critical care and examines the foundations of ethical thought upon which such decisions can be based. Understanding the overall cost containment movement as well as the potential problems associated with medical gatekeeping will allow critical care practitioners to better deal with the ethical dilemmas of today as well as help them anticipate those that will arise in the near future.

Cost Control↗
PubMed1999

Rationing health care: an exploration.

Rationing involves a failure to offer care, or the denial of care, from which patients would benefit. Rationing involves definition of efficiency (benefit) and equity (fairness) allocation criteria and a recognition of a trade-off between the two. However, accountability for rationing choices also requires careful governance of the agents of society, doctors, who judge the health needs of competing patients. An integrated rationing system requires management of patient access criteria, the knowledge base which informs practice and clinical practices.

Choice Behavior↗
PubMed1995

Rationing health care: preparing for a new era.

As the American health care system struggles to provide universal access to quality care at an acceptable price, many planners focus on rationing as the only way to make available the necessary resources. I discuss some of the ethical, economic, and political issues that relate to health care rationing. The four important questions to consider when examining a rationing plan are: (1) Who acts as the gatekeeper? (2) What kinds of goods or services are rationed? (3) What happens to the money and resources that are saved by rationing? (4) Does the system provide a safety valve for the well-to-do? This article examines two prototypical rationing systems--the British system and the Oregon plan--and answers these four questions for both systems. Because of the absence of an efficient market economy in health care and the certainty of resource constraints, rationing is inevitable in American health care. The primary issues are whether rationing will be done implicitly or explicitly and whether it will be based primarily on ability to pay (as in the present system) or on comparative judgments about the costs and benefits of medical interventions.

Ethics, Medical↗
PubMed1995

Rationing health care.

What health services should governments pay for? Who should receive transplants or expensive procedures? What services should be available through private insurance? Should there be a two-tiered system? And, how do we decide on what services to publicly insure/fund? Many governments around the world are facing such questions. In Canada, the Government of Alberta and the Reform Party of Canada have recently expressed the need to re-think which health services are publicly funded, or the "comprehensiveness" of Canada's health care system.

Canada↗