Equity and rationing in the NHS: past to present

Malone, Nelson C.; Rycroft-Malone, Joanne

doi:10.1046/j.1365-2834.1998.00086.x

Cited by 8 publications

(4 citation statements)

References 19 publications

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“…After the major decentralisation that occurred in 1993, Finnish municipalities (numbering 448) were allocated a strong autonomous role in health-care service provision. The steering role of the central government became less significant with regard to social and health issues, and the responsibility of health-care prioritisation was transferred from the national to the local level (compare the situation in UK, Malone & Rycroft-Malone, 1998). Municipal prioritisation processes have, however, been described as a heterogeneous phenomenon with varying goals, from preventing democracy deficit to listing targets for cutbacks (Knuutinen, 1998).…”

Section: Politicians As Key Actors In Priority-setting Processesmentioning

confidence: 99%

Social and health‐care priorities of local politicians in Finland: do the attitudes of politicians reflect the actual processes in municipalities?

Lammintakanen

Kinnunen

2004

Int J Soc Welfare

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The aim of this study was to find out whether elected politicians’ attitudes influence policy‐making processes in terms of social and health‐care resource allocation. A preliminary hypothesis was developed on the basis of previous empirical findings on the attitudes of politicians. If health‐care costs decreased during the period 1993–1999, then secondary care costs should have increased and vice versa; if the total amount of resources increased, then secondary care must have been allocated fewer resources. However, the results of this study showed that the actual resource‐allocation processes did not reflect the attitudes of local politicians. Expenditure on secondary health care increased during this period, while primary health‐care services were allocated fewer resources. Analysing the actual decision‐making processes rather than investigating attitudes to priority setting may prove more useful in gaining a better understanding of priority‐setting processes and the mechanisms used in different contexts.

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Section: Politicians As Key Actors In Priority-setting Processesmentioning

confidence: 99%

Social and health‐care priorities of local politicians in Finland: do the attitudes of politicians reflect the actual processes in municipalities?

Lammintakanen

Kinnunen

2004

Int J Soc Welfare

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“…The lead in the fight against rationing was left to philosophers (e.g. [12] and ethicists (e.g. [1]).…”

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confidence: 99%

Rationing of health care: is there an economic rationality to it?

Zweifel

2015

Eur J Health Econ

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The point of departure of this Editorial is the fact that we all are engaged in self-rationing in our everyday lives. We would like to spend more money on all sorts of nice things and devote more time to our cherished activities. Imposed rationing is characteristic of wartime governments, who seek to prevent the rich from gobbling up the resources left by the army. Since the publication in 1987 of David Callahan's Setting Limits: Medical Goals in an Aging Society (Callahan, Setting limits: medical goals in an aging society, Simon & Schuster, New York, 1987), rationing of health care has become a widely debated issue (the Internet is full of pertinent entries). While rationing has also been addressed by health economists, there are three puzzling observations. First, Callahan (Callahan, Setting limits: medical goals in an aging society, Simon & Schuster, New York, 1987) wrote for an American audience whereas rationing was introduced by the British National Health Service (NHS) well before 1987, with little debate. Second, the economic theory of rationing had been laid out by James Tobin [Ectrica 20(4): 521-533, 1952] as early as 1952-but health economists seem to have neglected his groundwork when writing about rationing. Third, they accept government-imposed rationing as inevitable in the case of health care, as though the selfrationing alternative was unavailable. An attempt is made here to provide rational explanations for these puzzles.Demand for rationing is induced by health insurance (and even more so, NHS provision)A well-known side effect of insurance is moral hazard. In the case of health, consider Mr X who is willing to pay €100 out of pocket for a drug, and let the rate of copayment be 33 percent. Evidently, the drug may cost as much as €300 at the pharmacy, and Mr X will still buy it. In this case, insured patients' marginal willingness to pay is inflated by a factor of three, the inverse of the rate of copayment. In Fig. 1, the 'true' demand function D oop (reflecting marginal willingness to pay out of pocket) is swiveled around to become the observed demand function D obs Ins (as seen by the pharmacist in the example). Given a positively sloped supply function S, the market equilibrium moves from E to E Ins . The prediction is clear: health insurance coverage causes an increase in the price of health care p M , the quantity of healthcare services M transacted, and hence healthcare expenditure HCE ¼ p M Â M. These effects are the more pronounced, the lower the rate of copayment.In a NHS promising access to care free of charge (as the British NHS originally did), observed demand does not react to price. Therefore, D obs NHS runs vertical, giving rise to equilibrium at E NHS which reflects even stronger moral hazard effects than the insurance-cum-copayment alternative. In the words of NHS historian Geoffrey Rivett [19], writing about the 1960s, ''Costs kept rising. The BMJ (British Medical Journal) believed that, ignoring the British capacity for muddling through, the NHS was heading in the...

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“…The cost of the NHS quickly became unmanageable leading to the introduction of charges for prescriptions and optical services within three years of its creation. Despite the continuation of these charges the net cost of the NHS has continued to rise inexorably, from three per cent of GDP in 1948 to seven per cent of a significantly larger GDP sixty years later (Crisp, 2002;Culyer, 1976, Chapter 2;Malone and Rycroft-Malone, 1998;Meadowcroft, 2008).…”

Section: What Constitutes 'Basic' Healthcare?mentioning

confidence: 99%

Just Healthcare? The Moral Failure of Single-Tier Basic Healthcare

Meadowcroft

2015

Journal of Medicine and Philosophy

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This article sets out the moral failure of single-tier basic healthcare. Single-tier basic healthcare has been advocated on the grounds that the provision of healthcare should be divorced from ability to pay and unequal access to basic healthcare is morally intolerable. However, single-tier basic healthcare encounters a host of catastrophic moral failings. Given the fact of human pluralism it is impossible to objectively define "basic" healthcare. Attempts to provide single-tier healthcare therefore become political processes in which interest groups compete for control of scarce resources with the most privileged possessing an inherent advantage. The focus on outputs in arguments for single-tier provision neglects the question of justice between individuals when some people provide resources for others without reciprocal benefits. The principle that only healthcare that can be provided to everyone should be provided at all leads to a leveling-down problem in which advocates of single-tier provision must prefer a situation where some individuals are made worse-off without any individual being made better-off compared to plausible multi-tier alternatives. Contemporary single-tier systems require the exclusion of noncitizens, meaning that their universalism is a myth. In the light of these pathologies, it is judged that multi-tier healthcare is morally required.

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Equity and rationing in the NHS: past to present

Abstract: Rationing of healthcare resources is thought to be inevitable as demands for healthcare increase in a funds-limited service. Rationing of resources is a political problem that requires some form of guidance from central government.

Cited by 8 publications

References 19 publications

Social and health‐care priorities of local politicians in Finland: do the attitudes of politicians reflect the actual processes in municipalities?

Social and health‐care priorities of local politicians in Finland: do the attitudes of politicians reflect the actual processes in municipalities?

Rationing of health care: is there an economic rationality to it?

Just Healthcare? The Moral Failure of Single-Tier Basic Healthcare

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