Health care rationing

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Health care rationing refers to mechanisms that are used for resource allocation ( viz. ration) in health care.

Contents

Overall health care

United States

Healthcare rationing in the United States of America is largely accomplished through market forces, though major government programs include Medicare, Medicaid, Veterans Affairs, and the Indian Health Service. Most Americans have private health insurance, and non-emergency health care rationing decisions are made based on what the insurance company or government insurance will pay for, what the patient is willing to pay for (though health care prices are often not transparent), and the ability and willingness of the provider to perform uncompensated care. The Emergency Medical Treatment and Active Labor Act of 1986 requires any properly equipped hospital receiving Medicare funds (nearly all private hospitals) to provide emergency healthcare regardless of citizenship, immigration status, or ability to pay. The government also regulates insurance policies, requiring coverage for some items and controlling the rules for who is eligible and what they can be charged. [1] The 2010 Patient Protection and Affordable Care Act (known as the PPACA or Obamacare) contained many changes to these regulations, including the first requirement that all Americans purchase health insurance (starting in 2014), which significantly changed the calculus of rationing decisions, including for preventive care.

United Kingdom

In the United Kingdom, the National Institute for Health and Care Excellence (NICE) sets coverage requirements for the National Health Service (NHS), which is funded and operated by the government. NICE calculates an incremental cost-effectiveness ratio in terms of quality-adjusted life years (QALY). Treatments under £20,000 per QALY gained are considered cost-effective, but those above £30,000 per QALY are rarely approved. Individuals who are able to do so may also pay for private treatments beyond what the NHS offers, but low-income people largely have equal access to health care. The overall level of government funding for NHS is a political issue in the UK. Local decisions about service provision in England are made by clinical commissioning groups.

As pressures on the NHS have increased there have been increasing local moves to restrict non urgent surgery for obese patients and smokers. Funding for in vitro fertilisation is reduced from three cycles to one for patients who meet the criteria; that female sterilisation is only funded in exceptional circumstances; gluten free food will not be available on prescription for most patients who need it; and over the counter medicines will no longer be prescribed except in exceptional circumstances. [2]

In 2006 Croydon Primary Care Trust produced a list of 34 procedures of limited clinical effectiveness which was circulated widely within the English NHS. Some were largely cosmetic, and others were used on patients who were unlikely to benefits from them. The London Health Observatory calculated that these procedures amounted to between 3% and 10% of clinical activity and that the resources could be used more effectively. [3] A similar list was produced by NHS England in June 2018. It is proposed that surgery for snoring, dilatation and curettage for heavy menstrual bleeding, knee arthroscopies for osteoarthritis and injections for non-specific back pain will only be available in exceptional circumstances.

Specific eligibility criteria will be produced for

This would affect about 100,000 patients every year and is claimed to free up about £200 million. [4]

See also NHS treatments blacklist.

Economic totalitarian market-driven medical welfare state in the Netherlands

An economic totalitarian medical welfare state is a welfare state program that has pushed out the market economy for health care, which was offering health care directly to patients on contract basis, meaning that patients cannot buy health care anymore. This is achieved by (1) coercing insurance companies, by regulatory law, to accept all customers or patients applying for the state-regulated public basic medical insurance policy, while (2) the regulation for this policy, requires egalitarian treatment of all customers or patients offered health care and the reimbursement of all health care treatment prescribed by a gatekeeper medical doctors to public basic medical insurance patients, and (3) basic insurance policy is obligatory for all residents in a country. [5] It may be referred to as a form of Rhenish capitalism. While this system allows for a broad private enterprise market of health care services offered only to public basic insured patients with prescriptions from a gatekeeper, this system has the side-effect of the driving out of health care offered to patient seeking individually contracted medical services without gatekeeper doctors prescription. It therefore eliminates the market economy in health care. [6] This system effectively puts all residents on a medical welfare program, offered by private enterprise (market-driven), which is rationing medical services and goods. For this medical system the quality of its goods and services cannot be independently verified by free individual contract, and therefore the people have to rely on this medical system itself to verify the quality of its own services. [7] [8] [9]

An example of the market-driven medical welfare state is the public healthcare system in the Netherlands, where these insurance companies receive, from tax revenue, an additional leverage sum with respect to the premium of at least a factor 6 [10] . Although this policy eliminates one form of healthcare rationing namely waiting lines in the welfare state, it actually implements another type, namely 'rationing by a necessity scheme'. For example preventive healthcare services for the general risk group, like blood tests, endoscopy's and MRI scans are not provided by the gatekeeper and scarcely available in the market. [5]

The market-driven medical welfare state is a form of economic totalitarian welfare-state capitalism, [11] [12] [13] in the sense that there is private enterprise free-market but no patient contracting (also called 'over-the-counter') free-market. The public medical insurance policy becomes a compulsory cartel of private-enterprise public insurance companies and medical goods and services companies which results in an effective government-granted monopoly of these medical goods and services. It distributes medical goods and services to the patients in a Marxist egalitarian way, but does not use the classical Marxist state ownership of all means production. Note that Marxist egalitarianism can, in reality, be of the middle-stage or end-stage type depending whether distribution happens according to contribution or necessity. Formally the gatekeeper general practitioners will determine the necessity of treatment and diagnostic health care.

The income of people working in the market-driven welfare state consisting of the public health care policy basic insurance, the corresponding insurance companies and the public health care service providers like public hospitals, private clinics and practices, which is based on mandatory premiums and state tax revenue contribution, does no longer directly depend on the forces of supply and demand, this works out particularly bad in country wide medical emergency situations, where the self-preservation of the medical welfare-state workers does not ultimately depend on servicing the patient customers. A principle that is firmly secured by Adam Smith's invisible hand serving the common good.

Rationing of health care in Germany

Israel

Armed Hamas gunmen hijacking patient in hospital. Armed Hamas gunmen taking a hostage through Al Shifa Hospital.jpg
Armed Hamas gunmen hijacking patient in hospital.

Even though Netanyahu claims to have liberally reformed Israel to a market economy it is still using a communist health care system because Israel's health care system is still based on Marxist egalitarian distribution of health care services. [14] [15] By law every patient requires a referral/prescription of a gatekeeper doctor, usually the general practitioner for most health care services, even if this serves no purpose, such as for example with preventive MRI scans or dental checkup's. Even though you can acquire a private general practitioner there is no guarantee that one will prescribe you a preventive diagnostic treatment, while a consult usually costs the equivalent of about 200-300 USD, and all diagnostics can possibly burden the public health care system. [16] [17]

Shortages

Shortages of donated organs for transplantation has resulted in the rationing of hearts, livers, lungs and kidneys in the United States, mediated by the United Network for Organ Sharing. During the 1940s, a limited supply of iron lungs for polio victims forced physicians to ration these machines. Dialysis machines for patients in kidney failure were rationed between 1962 and 1967.[ citation needed ] More recently, Tia Powell led a New York State Workgroup that set up guidelines for rationing ventilators during a flu pandemic. [18] [19] Among those who have argued in favor of health care rationing are moral philosopher Peter Singer [20] and Oregon governor John Kitzhaber.

See also

Related Research Articles

Health care reform is for the most part governmental policy that affects health care delivery in a given place. Health care reform typically attempts to:

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<span class="mw-page-title-main">Healthcare industry</span> Economic sector focused on health

The healthcare industry is an aggregation and integration of sectors within the economic system that provides goods and services to treat patients with curative, preventive, rehabilitative, and palliative care. It encompasses the creation and commercialization of products and services conducive to the preservation and restoration of well-being. The contemporary healthcare sector comprises three fundamental facets, namely services, products, and finance. It can be further subdivided into numerous sectors and categories and relies on interdisciplinary teams of highly skilled professionals and paraprofessionals to address the healthcare requirements of both individuals and communities.

Health insurance or medical insurance is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among many individuals. By estimating the overall risk of health risk and health system expenses over the risk pool, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization, such as a government agency, private business, or not-for-profit entity.

<span class="mw-page-title-main">Two-tier healthcare</span> Unequal access to higher quality healthcare

Two-tier healthcare is a situation in which a basic government-provided healthcare system provides basic care, and a secondary tier of care exists for those who can pay for additional, better quality or faster access. Most countries have both publicly and privately funded healthcare, but the degree to which it creates a quality differential depends on the way the two systems are managed, funded, and regulated.

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<span class="mw-page-title-main">NHS Scotland</span> Publicly-funded healthcare system in Scotland

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<span class="mw-page-title-main">Healthcare in the United Kingdom</span> Overview of healthcare in the United Kingdom

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<span class="mw-page-title-main">National Health Service (England)</span> Publicly-funded healthcare system in England

The National Health Service (NHS) is the publicly funded healthcare system in England, and one of the four National Health Service systems in the United Kingdom. It is the second largest single-payer healthcare system in the world after the Brazilian Sistema Único de Saúde. Primarily funded by the government from general taxation, and overseen by the Department of Health and Social Care, the NHS provides healthcare to all legal English residents and residents from other regions of the UK, with most services free at the point of use for most people. The NHS also conducts research through the National Institute for Health and Care Research (NIHR).

<span class="mw-page-title-main">Healthcare in the Netherlands</span>

Healthcare in the Netherlands is differentiated along three dimensions (1) level (2) physical versus mental and (3) short term versus long term care.

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<span class="mw-page-title-main">Healthcare in Taiwan</span>

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<span class="mw-page-title-main">Health facility</span> Any location at which medicine is practiced regularly

A health facility is, in general, any location where healthcare is provided. Health facilities range from small clinics and doctor's offices to urgent care centers and large hospitals with elaborate emergency rooms and trauma centers. The number and quality of health facilities in a country or region is one common measure of that area's prosperity and quality of life. In many countries, health facilities are regulated to some extent by law; licensing by a regulatory agency is often required before a facility may open for business. Health facilities may be owned and operated by for-profit businesses, non-profit organizations, governments, and, in some cases, individuals, with proportions varying by country. See also the recent review paper,

<span class="mw-page-title-main">Healthcare in Portugal</span>

Healthcare in Portugal is provided through three coexisting systems: the National Health Service, special social health insurance schemes for certain professions and voluntary private health insurance. The SNS provides universal coverage, although in 2012 measures were implemented to ensure the sustainability of the service by the introduction of user fees to be paid for at the end of treatments. In addition, about 25% of the population is covered by the health subsystems, 10% by private insurance schemes and another 7% by mutual funds. The Ministry of Health is responsible for developing health policy as well as managing the SNS. The Health Regulatory Entity (ERS) is the public independent entity responsible for the regulation of the activity of all the public, private and social healthcare providers. In 2019 the government proposes to scrap all fees, which constitute about 2 percent of the NHS's budget, apart from some hospital emergencies.

<span class="mw-page-title-main">Private healthcare in the United Kingdom</span>

Private healthcare in the UK, where universal state-funded healthcare is provided by the National Health Service, is a niche market.

References

  1. ↑ Reinhardt, Uwe E. (July 3, 2009). "'Rationing' Health Care: What Does It Mean?". The New York Times.
  2. ↑ "CCGs demand patients lose weight or face indefinite wait for surgery". Health Service Journal. 17 October 2017. Retrieved 23 December 2017.
  3. ↑ "NHS Haringey paper for the Overview and Scrutiny Committee on low priority treatments". Haringey PCT. 13 April 2010. Retrieved 30 June 2018.
  4. ↑ "NHS England to stop 'ineffective' treatments". BBC. 30 June 2018. Retrieved 30 June 2018.
  5. 1 2 https://www.zorginstituutnederland.nl/Verzekerde+zorg/zvw-algemeen-hoe-werkt-de-zorgverzekeringswet How does the Health Insurance Act (NL) work? – Insured care – National Healthcare Institute. Zorgverzekering (Nederland)
  6. ↑ Thousands of Netherlands residents on lengthy waiting lists for primary doctors. https://nltimes.nl/2024/03/21/thousands-netherlands-residents-lengthy-waiting-lists-primary-doctors
  7. ↑ Verify yourself at the largest private diagnostic healthcare provider in the Netherlands, whether colonoscopy and gastroscopy's are available: prescan.nl. (+31 74 255 9255)
  8. ↑ Verify yourself why www.bloedwaardentest.nl the largest private supplier of blood tests in NL does not perform it's laboratory services with any dutch laboratory and has all it's samples transported to Germany.(+31 85 065 37 47)
  9. ↑ Verify yourself why www.bergmanclinics.nl the largest private supplier of medical services in NL offers it's services only and normally with a prescription from a gatekeeper.(+31 88 9000 500)
  10. ↑ In the Netherlands: Average yearly medical premium of 1200 euros. Average medical expenses 2022 are 7129 euros. https://www.cbs.nl/nl-nl/nieuws/2023/27/zorguitgaven-stegen-in-2022-met-1-2-procent
  11. ↑ Friedman, Milton (1962). Capitalism and Freedom. p. 17. ISBN   0-226-26421-1.
  12. ↑ Von Mises, Ludwig (1952). Planning for Freedom. p. 1.
  13. ↑ Bergh, Andreas (2014). Sweden and the Revival of the Capitalist Welfare State.
  14. ↑ Health Reform And Rationing in Israel - David Chinitz and Avi Israelihttps://www.healthaffairs.org/doi/10.1377/hlthaff.16.5.205
  15. ↑ Circles of exclusion: obstacles in access to health care services in Israel - Dani Filc https://pubmed.ncbi.nlm.nih.gov/21058539/
  16. ↑ Verify for yourself that you cannot order an MRI scan at private hospital www.assutacenter.com, Tel Aviv, without a gatekeeper's prescription. (+972-54-659-8262)
  17. ↑ Verify for yourself that you cannot order an MRI scan at private hospital eng.medassist.co.il, Tel Aviv, without a gatekeeper's prescription. (+972 37724228)
  18. ↑ "Guidelines" (PDF). Archived from the original (PDF) on 2011-09-27. Retrieved 2013-09-02.
  19. ↑ Cornelia Dean, Guidelines for Epidemics: Who Gets a Ventilator?, The New York Times, March 25, 2008
  20. ↑ Why We Must Ration Health Care , The New York Times, July 15, 2009
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