The secret art of managing healthcare expenses: investigating implicit rationing and autonomy in public healthcare systems

Lauridsen, Sigurd; Norup, Michael; Rossel, Peter

doi:10.1136/jme.2006.018523

Cited by 15 publications

(16 citation statements)

References 22 publications

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“…First, healthcare funding decisions determine how collective resources are allocated so they concern society generally. Individuals have interests in funding decisions as recipients of healthcare (individual interests) and as members of society (collective interests) 23. If decisions are made in secrecy, citizens cannot monitor or protect their (individual and collective) interests.…”

Section: The Role Of Publicity Within Accountability For Reasonablenessmentioning

confidence: 99%

Publish or be damned: Individual Funding Requests and the publicity condition

2013

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Many jurisdictions have processes to consider Individual Funding Requests but, with few exceptions, the decisions made with respect to these are not made public. Drawing upon Daniels and Sabin's account of the requirements of procedural justice, Accountability for Reasonableness, this paper considers several arguments for and against publishing individual funding request decisions. After briefly reviewing the case for publicity as a requirement of procedural justice and canvassing several arguments against publicity, we consider whether patient confidentiality justifies suppressing funding decisions. We claim that, with one possible exception, publication of individual funding request decisions does not raise concerns that are different in kind from those that apply to publication of legal judgments relating to healthcare, and that the protections instituted in that setting should be sufficient to allow publication of funding decisions. The discussion concludes with several cautionary notes.

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Section: The Role Of Publicity Within Accountability For Reasonablenessmentioning

confidence: 99%

Publish or be damned: Individual Funding Requests and the publicity condition

2013

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“…While rationing is generally viewed in terms of offering limited services or therapies to save costs,15 purposely failing to inform patients they may come in contact with a reprocessed SUI as a cost saving measure, despite the availability of a previously unused item, is a form of hidden rationing. Extended further, decision making has not been shared between the patient and healthcare provider, and the criteria for informed consent has not been met 15. The conflict between utilitarianism and contractarianism is evident in this issue.…”

Section: Informing the Patientmentioning

confidence: 99%

Is once always enough? Revisiting the single use item

Moszczynski¹

2009

J Med Ethics

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The reuse of single use medical items is a complex ethical issue that many healthcare providers are faced with, for while recommendations and literature do not advocate the reuse of these items, the reality is that many single use items are frequently reused. Further, many healthcare workers are ethically divided over whether or not to share this information with their patients, or who should reveal this information. While single use items are convenient to use, the reality of the cost to the healthcare system and the environment is being realised. Three distinct issues in regard to reuse of single use items are explored: patient consent, fiscal responsibility and environmental stewardship. Exploring these issues through the ethical frameworks of utilitarianism, contractarianism, and land ethic or holism can offer guidance in attending to the question "is once always enough?" Applying an integrated ethical framework can further assist healthcare providers and stakeholders to make informed, ethical choices in regard to choosing single use medical devices and items. Short, fictionalised narratives based on authentic events are used to illustrate the ethical context of the reuse issue.

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“…(5,7) When bedside rationing is done without revealing the decision to ration or its rationale to the patient, it quali es as hidden bedside rationing. (2,8) Hidden bedside rationing can result in unfair inequality and illegitimate distribution of resources. (9)(10)(11)(12) Furthermore, it opens up the possibility for distribution or restriction of resources based on clinically irrelevant characteristics such as ethnicity, gender, age or skin colour.…”

Section: Introductionmentioning

confidence: 99%

Hidden Bedside Rationing in the Netherlands: a Cross-sectional Survey Among Internists

Ruijter¹,

Lingsma²,

Bax³

et al. 2020

Preprint

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Background Healthcare rationing can be defined as withholding beneficial care for cost reasons. One form in particular, hidden bedside rationing, is problematic because it may result in conflicting loyalties for physicians, unfair inequality among patients and illegitimate distribution of resources. Our aim is to establish whether bedside rationing occurs in the Netherlands, whether it qualifies as hidden and what physician characteristics are associated with its practice.Methods Cross-sectional online questionnaire on knowledge of -, experience with -, and opinion on rationing among physicians in internal medicine within the Dutch healthcare system. Multivariable ordinal logistic regression was used to explore relations between hidden bedside rationing and physician characteristics.Results The survey was distributed among 1139 physicians across 11 hospitals with a response rate of 18% (n=203). Most participants (n=129; 64%) had experience prescribing a cheaper course of treatment while a more effective but more expensive alternative was available, suggesting bedside rationing. Subsequently, 32 (24%) participants never disclosed this decision to their patient, qualifying it as hidden. The majority of participants (n=153; 75%) rarely discussed treatment cost. Employment at an academic hospital was independently associated with more bedside rationing (OR=17 95%CI 6.1-48). Furthermore, residents were more likely to disclose rationing to their patients than internists (OR=3.2, 95%CI 2.1-4.7), while salaried physicians were less likely to do so than physicians in private practice (OR=0.5, 95%CI 0.4-0.8).Conclusion Hidden bedside rationing occurs in the Netherlands: patient choice is on occasion limited with costs as rationale and this is not always disclosed. The questions of how distribution of healthcare ought to take place, and to what degree that should include bedside rationing, remain topical and warrant a more public debate.

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The secret art of managing healthcare expenses: investigating implicit rationing and autonomy in public healthcare systems

Cited by 15 publications

References 22 publications

Publish or be damned: Individual Funding Requests and the publicity condition

Publish or be damned: Individual Funding Requests and the publicity condition

Is once always enough? Revisiting the single use item

Hidden Bedside Rationing in the Netherlands: a Cross-sectional Survey Among Internists

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