Rationing Health Care: The Choice Before Us

Abstract

Rapid technological advances and upward pressure on wages of hospital personnel are leading to a steady increase in health care spending that is absorbing an ever-larger fraction of gross national product. Eliminating inefficiencies in the system can provide brief fiscal relief, but rationing of beneficial services, even to the well-insured, offers the only prospect for sustained reduction in the growth of health care spending. The United States, which has negligible direct experience with rationing, can learn about choices it will face from the experience of Great Britain where health care has been rationed explicitly for many years.

Short-Rerm Mortality Predictions for Critically Ill Hospitalized Adults: Science and Ethics

“…Increased research and development on predictive methods in medical science could counterbalance these trends by encouraging priority determinations based on the relative ability to benefit from medical services (52). Objective probability estimates offer the promise of more equitable and ethically appropriate delivery of advanced medical care to individuals as well as to populations.…”

The pros and cons of evidence-based surgery

“…Politicians and health economists all over the western world are currently facing budget problems of their national healthcare systems [1]. Clinicians should not delude themselves with the hope that the financial problems in healthcare simply will go away again.…”

“…We can no longer expect the medical and economic aspects of care to be considered separately [38]. In many countries, it is already a clinical reality to deny special diagnostic or therapeutic options to patients or subgroups of patients [1,72]. To date, no consensus exists regarding to which patients medical care should be offered and to which it should be denied [56].…”

A Different View of Queues in Ontario

“…If queues exist in an expensive, publicly administered system such as Canada's, additional point is given to the debate between the "rationalizers" and the "rationers." 37 The former group argue, in a nutshell, that systematic reform of health care can permit all citizens of a given industrialized country to receive all necessary services at an overall cost that most societies can shoulder without undue impingement on other public and private expenditures that contribute to quality of life. The latter argue either that such reforms cannot be implemented or that, if implemented, they will not suffice to avert the need for some persons to be denied some services that would prolong or improve their lives.…”