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.

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. [5] [6] Among those who have argued in favor of health care rationing are moral philosopher Peter Singer [7] and Oregon governor John Kitzhaber.

See also

Related Research Articles

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Medicare is an unofficial designation used to refer to the publicly funded single-payer healthcare system of Canada. Canada's health care system consists of 13 provincial and territorial health insurance plans, which provide universal healthcare coverage to Canadian citizens, permanent residents, and depending on the province or territory, certain temporary residents. The systems are individually administered on a provincial or territorial basis, within guidelines set by the federal government. The formal terminology for the insurance system is provided by the Canada Health Act and the health insurance legislation of the individual provinces and territories.

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<span class="mw-page-title-main">National Institute for Health and Care Excellence</span> Non-departmental public body of the Department of Health in the UK

The National Institute for Health and Care Excellence (NICE) is an executive non-departmental public body, in England, of the Department of Health and Social Care, that publishes guidelines in four areas:

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Healthcare rationing in the United States exists in various forms. Access to private health insurance is rationed on price and ability to pay. Those unable to afford a health insurance policy are unable to acquire a private plan except by employer-provided and other job-attached coverage, and insurance companies sometimes pre-screen applicants for pre-existing medical conditions. Applicants with such conditions may be declined cover or pay higher premiums and/or have extra conditions imposed such as a waiting period.

<span class="mw-page-title-main">Clinical commissioning group</span> Healthcare organisation in the United Kingdom

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Healthcare in London, which consumes about a fifth of the NHS budget in England, is in many respects distinct from that in the rest of the United Kingdom, or England.

<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. ↑ "Guidelines" (PDF). Archived from the original (PDF) on 2011-09-27. Retrieved 2013-09-02.
  6. ↑ Cornelia Dean, Guidelines for Epidemics: Who Gets a Ventilator?, The New York Times, March 25, 2008
  7. ↑ Why We Must Ration Health Care , The New York Times, July 15, 2009
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