Rationing has always been present in medical practices. Rationing of health care is the withholding of potentially beneficial medical services to an individual because those services were not intended to be provided for everybody but to those capable of payment for a particular medical service. Usually this is implemented in areas where there is limited resources and budget allocated for Medical services and care (Aaron, 2005).
With this action, individuals and institutions that are involved in this kind of practice are being criticized. Institutions like private enterprises dealing with health insurance policies like HMO’s.
Health Care Rationing
Rationing of health services is one of the approach and policies implemented by most countries. The primary intention for this is the conservation of limited resources for medical services and to ensure that service is available when it is most needed.
There was one definition which described rationing as to ration health care is to withhold at least some medical services from at least some individuals who would probably benefit from them, because we have decided not to buy those services for everybody who needs them (“The truth about health care rationing,” 2000). And there are even critics regarding calling this procedure as “rationing” instead using other terms like “resource allocation” due to the negative connotation derived from the term rationing.
Health care rationing is manifested in several forms. The primary form of rationing is self rationing. Here the individual gauges the cost of having medical service compared to the expected benefits (Goodman & Musgrave, 2001). He or she is given the choice if the service they want to avail is worth the money, time and effort that they would exert.
Bureaucratic rationing is when government or policy making bodies impose policies and guidelines for medical and health services. Mostly affected with this type is the allocation of funds and limits on the number of health care provider and facilities (Goodman & Musgrave, 2001).
Another form of health rationing practice which is the most criticized is in the form of health maintenance organizations or HMO’s (Friedenberg, 2003).
Rationing of medical service has been one of the topics of discussion in the ethical arena of Medical services. The debate on whether the practice of rationing of health care is ethically acceptable.
Goodman and Musgrave argued that with rationing of health service, especially if policies are decided by bureaucrats, discrimination would become evident. Policies and guidelines would lean towards the wealthy and other marginal criteria like sex and age (Goodman & Musgrave, 2001).
This is evident mostly in other countries utilizing a single-payer system like Canada, New Zealand and Australia (Tanner, 1996). Based on statistics, these countries have had higher incidents of patients being denied medical services especially those with poor prognosis. Availability of medical service is also being questioned especially new technology and techniques. This system also places a heavy burden on the part of the beneficiaries. They deal with higher taxes with the addition mostly used to finance this type of government controlled health policies and system.
But there are those citing that the results indicated in the countries mentioned are not the direct results of having a single payer scheme but can be attributed to other factors like politics and commercialization (Tanner, 1996).
There are those who argue that rationing deprives the individual of choice since most of them did not choose to seek medical care due to high cost. There are arguments for the availability of service but this can be attributed to the health care provider and not to the individual.
It would be beneficial if we look upon also the purpose of health care rationing. The control of ever increasing health care expenditures is one of the reasons why governments came up with policies like rationing of health care. In theory these policies were created to sustain the country economy and still be able to provide health care services, though controlled and marginalized (Aaron, 2005).
But what is the effect of this scheme to health care seekers? We can view different stories and different angles. But mostly what is considered first by would be patients are their economic standing (Tanner, 1996).
Majority of the marginalized individuals affected by these rationing policies are those who don’t have sufficient funds to procure much needed medical service. And it was their option not to avail of such services.
Majority of the debate regarding health care rationing revolves around the topic is whether medical ethics are justified with the scheme.
With rationing of health service, is the patient deprived of needed medical service? On a policy level, one of the reasons why the scheme was formulated and implemented is to make sure that medical service would be available. Regulatory policies for health care were intended not to marginalize but to ensure that medical service would be available, sustainable and attainable (S, R, & EA., 1999).
Most countries have managed to provide health care service. Although there are still social issues and disparities that needed to be settled first but still adequate health care is provided for the country’s citizens (Friedenberg, 2003).
On the individual level the two points for consideration are choice and capacity. Patients always have the choice if they want to access or procure certain medical service. The next consideration is their capability of procuring such medical service. Rationing policies would affect the individual in the screening process for the service that they want to avail. But still this does not hinder them from consulting their physician. Choice is still within the hands of the individual patient (Goodman & Musgrave, 2001).
One of the reasons why medical insurance companies proliferate is with the high cost of medical services. In order for beneficiaries to be provided with needed medical attention they need to subscribe to a medical savings policy to pay up in the event of emergencies and acquire needed medical services. But since this is a profit oriented organization, their main thrust is how to have higher earning with providing health service to their beneficiary only secondary.
For health care providers, individually rationing of health service is predominantly evident at their level when dealing with specialized medical service. Ethics dictates that they provide the best possible medical service in their capacity but rationing is mostly evident in the screening process thus limiting the recipient of their expertise.
Health care services should be provided to those in need but still economic factors are needed to be considered. Since the service is not free, someone, whether an individual, group or an entity, should provide the necessary fund for the availing of the service.
Rationing is not desirable for it marginalizes and sometimes deprives patients of needed medical services. But if really necessary then rationing is the only alternative (“The truth about health care rationing,” 2000).
It would be better if steps are taken to minimize the effect of rationing. One suggestion was to have more attention given to preventive actions rather than utilize or concentrate on rationing policies (Tanner, 1996). This action is mainly due to limited medical resources, insufficient health care providers and budget constraints. Preventive care campaigns if successful will result to having a fewer patients needing medical services, equipments and resources like drugs and facilities. Focus on community health maintenance should be prioritized by policy making bodies.
Friedenberg suggested that a universal health care program be developed. One of the failings he cited with Managed care is that individuals have no coverage for a preset basic service that every one can avail. He suggested a system for universal health care that includes policies for upgrading, with the option of additional coverage (Friedenberg, 2003).
Defining a set of services to be classified as Basic Health service should be on of the priorities of Health Institutions and should be globally accepted. Having this set service policy makers worldwide can determine whether their health care programs are beneficial to the majority of their populations. They can allocate budget for the provisioning of these basic health services and do necessary option in the event of having insufficient funds.
It would be also beneficial if there would be a standard cost for these health care services accepted globally. Health care should be treated in a worldwide perspective. Discoveries and new technologies can be beneficial to the entire world.
Health care rationing might seem undesirable and filled with negative implications as experienced by victims of the system. But resources has to be managed and allocated properly lest the alternative of having a very high cost medical service.
If no regulations are set on medical service and institutions, then its price for services would shoot up and would eventually marginalized a higher percentage of the population.
One of the basic responsibilities that we entrust to our governments is provisioning of basic health care services. Policies and programs should focus on how to do this. The problem experienced by policy making bodies is the definitions of what to consider as a basic health service. If these health services can be clearly defined, then we can proceed with the next step, ensuring that these basic health services are provided. Thus Rationing would be limited to those services not classified as basic.
Government, medical practitioners and private institutions should work hand in hand in formulating policies that would be fair to all stake holders and with the public interest in mind.
There are other factors also affecting health care service. Addressing social and economic issues that influence health care provisioning would be beneficial. Uplifting the standard living conditions would also have a direct benefit for health care provisioning. If people are better financially and socially it might follow that they would also have better health conditions.
Debates would still continue whether Rationing of health services is ethically sound or not in the medical profession. But the main issue is not focused on the rationing; it should be on the reason why governments need to come up with policies like these. We can criticize also why health care service is very costly and very hard to afford in most countries.
Rationing is inevitable if issues like resource allocation and social discrepancies exist. If it is existent since the necessity dictates and no other alternative is present, then we could at least come up with a rationing scheme that would affect as few as possible. These guidelines must be studied carefully and justified.
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Friedenberg, R. M. (2003). Rationing in Health Care: Changing the Patterns of Health Care. Radiology, 5(8), 227.
Goodman, J. C., & Musgrave, G. L. (2001). Health Care Rationing [Electronic Version] from http://www.ncpa.org/~ncpa/w/w50.html.
S, S., R, L., & EA., N. (1999). The pros and cons of evidence-based surgery. Langenbeck’s archieve of surgery, 384(5), 423-431.
Tanner, M. (1996). HEALTH CARE REFORM: THE GOOD, THE BAD, AND THE UGLY [Electronic Version]. Retrieved may 16 from http://allnurses.com/forums/f100/debate-pros-cons-universal-health-care-8387.html.
The truth about health care rationing [Electronic (2000). Version]. Retrieved may 16 from http://www.yourdoctorinthefamily.com/grandtheory/section2_1.htm.