Rationing in the fiscal ice age

Κlein, Rudolf

doi:10.1017/s1744133110000095

Cited by 44 publications

(36 citation statements)

References 18 publications

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“…9,10 Rationing the different dimensions of coverage takes place at all levels, often in an implicit rather than explicit manner. 11 In line with the wider health system goals of transparency, accountability and patient responsiveness, the process of setting priorities and rationing coverage (particularly of publicly funded care) should be based on explicit criteria and a broad public debate involving government, providers, the public, and patients. 9,12 However, this does not regularly happen in practice and it is often easier for governments (or, in the US, employers) to instead exclude whole areas of services, such as dental care.…”

Section: Types Of Rationingmentioning

confidence: 99%

“…8 Furthermore, much "bedside" rationing by clinicians, such as on the basis of age, 13 has been traditionally implicit and unsystematic. 11,12 …”

Section: Types Of Rationingmentioning

confidence: 99%

“…Several high profile cases, however, demonstrated that the government, the pharmaceutical industry and the media continue to wield influence on NICE recommendations, raising the question of which social values to uphold and how to make decisions on them. 11,28,29 …”

Section: Resource Allocation and Rationing In Europementioning

confidence: 99%

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Ethics of Resource Allocation and Rationing Medical Care in a Time of Fiscal Restraint - US and Europe

Teutsch

Rechel

2012

Public Health Rev

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Background: All resources are scarce. The ethical dilemma in health care is how to balance the precepts of autonomy, beneficence, and distributive justice. Rationing may affect three dimensions of coverage: the share of the population covered, the services covered, and the extent to which services are covered. United States: The US spends 50 percent more per capita on health care than any other country while achieving worse health than many. Poorly coordinated insurance mechanisms leave 19 percent of the population uninsured. Until passage of the Patient Protection and Affordable Care Act (PPACA) in 2010, health care was effectively a privilege, not a right. While PPACA seeks to rectify this, by 2019 five percent of non-elderly US residents will likely remain uninsured. Europe: Most European countries provide universal or near-universal population coverage to people resident in the respective country. Central and Eastern European countries inherited the Soviet-era commitment to universal coverage free at the point of use. Faced with a decline in government spending on health, almost all of them reduced the scope of services and introduced official user fees. In contrast, other European countries expanded entitlement to publicly funded health care, resulting in greater equity. A number of countries have attempted to depoliticize decisions on rationing by using health technology assessments and dedicated agencies. Discussion: Resource allocation and rationing differ considerably between the US and Europe. In the US, where social welfare remains controversial, there are few restrictions on the use of health care technology regardless of cost or clinical effectiveness. European countries engage in more explicit debates about these limits, though these are complicated by media and lobby power.

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Section: Types Of Rationingmentioning

confidence: 99%

“…8 Furthermore, much "bedside" rationing by clinicians, such as on the basis of age, 13 has been traditionally implicit and unsystematic. 11,12 …”

Section: Types Of Rationingmentioning

confidence: 99%

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Ethics of Resource Allocation and Rationing Medical Care in a Time of Fiscal Restraint - US and Europe

Teutsch

Rechel

2012

Public Health Rev

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“…2 However, discussions of rationing over the past 5 years consistently note there is no agreed upon definition, and point out that the term is often used synonymously with ideas such as 'resource allocation,' 'priority setting' and 'cost containment.' [3][4][5][6] The political processes surrounding the Affordable Care Act in the United States, and the National Health Service in the United Kingdom have added to the conceptual and methodological struggle to measure and understand clinician attitudes and willingness to accept rationing either in their own practice or through policy measures. [3][4][5] Even what is considered rationing is unclear; for example, limitations on services by ability to pay, or lack of care resulting from lack of health insurance, is seen as implicit rationing by some definitions, but not others.…”

mentioning

confidence: 99%

“…[3][4][5][6] The political processes surrounding the Affordable Care Act in the United States, and the National Health Service in the United Kingdom have added to the conceptual and methodological struggle to measure and understand clinician attitudes and willingness to accept rationing either in their own practice or through policy measures. [3][4][5] Even what is considered rationing is unclear; for example, limitations on services by ability to pay, or lack of care resulting from lack of health insurance, is seen as implicit rationing by some definitions, but not others. 2 , 5 , 6 By not directly asking about rationing, Sheeler et al avoided possible reactions to the term itself, and stated this could prompt more professional discourse on the topic.…”

mentioning

confidence: 99%

Rationing of Care: Conceptual Ambiguity and Transparency in Data Collection and Synthesis

Walker

Egede

2016

J GEN INTERN MED

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R ationing continues to be a hotly debated and controversial issue, with great disagreement over not only whether rationing is acceptable, but what it means to ration care. In this issue of JGIM, Sheeler et al. present findings of a crosssectional study that aims to describe physician rationing behaviors and characteristics of rationing in the United States. 1 Surveys mailed to physicians randomly selected from the American Medical Association master file asked about frequency with which they Bpersonally refrained, because of cost to the health care system,^from using ten different interventions, including laboratory tests, magnetic resonance imaging (MRI), referral, or prescription drugs. They found overall that 53 % of respondents reported refraining from using services in the past 6 months. 1 Prescription drugs and MRI were most frequently reported at 48 % and 45 %, respectively. 1 Surgical and procedural specialists, medical school settings, and physicians who self-identified as very or somewhat politically conservative reported higher frequency of refraining from using at least one of the ten services than primary care, small or solo practice, and those identifying as very or somewhat liberal. 1 In addition, the survey asked respondents one of three randomly assigned questions to gauge perceived responsibility for containing costs, phrasing questions either as responsibility to Bexercise wise financial resource stewardship,^Bpromote cost consciousness^or Bration in my daily care of patients.Ĉ ompared to 88 % agreeing with the Bwise-stewardship^and 81 % agreeing with the Bcost-conscious^statements, only 22 % agreed with the Brationing^statement. 1

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Effective but costly: How to tackle difficult trade‐offs in evaluating health improving technologies in liver diseases

2016

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Rationing in the fiscal ice age

Cited by 44 publications

References 18 publications

Ethics of Resource Allocation and Rationing Medical Care in a Time of Fiscal Restraint - US and Europe

Ethics of Resource Allocation and Rationing Medical Care in a Time of Fiscal Restraint - US and Europe

Rationing of Care: Conceptual Ambiguity and Transparency in Data Collection and Synthesis

Effective but costly: How to tackle difficult trade‐offs in evaluating health improving technologies in liver diseases

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