What is health care rationing? ….The Kings Fund says to beware if it is not done by doctors… But they admit it has to happen (1999!!).. Rationing of services to patients is occurring but in a covert and post code manner different in different areas of the country. I would suggest that, if it is a National Health Service, that high end (expensive service) rationing should be universal and fair, but low end rationing could be local (and pragmatically but unfortunately unfair). Please let me have copy letters as examples of rationing – these will be listed at bottom of this page..
I welcome suggestions to new links and articles regarding overt rationing around the world. Please contact me if you can make a contribution. The Nuffield Trust and the Kings fund are clear that we should be thinking about it, and if it has to be, that rationing should be overt. One of its foremost thinkers is John Appleby. If you would like to download the Kings fund document (2012) it is here.
The House of Lords has a Committee to consider the impact of demograhic changes on Public Services. Its original background report and “call for evidence” (also on You Tube) has been met, and the conclusion as reported in the BBC, is that we are woefully unprepared and that public services may disintegrate if we do not reconstruct and re-invent them.
There will be much debate about methodology once rationing is accepted. A suggested model comes from Holland.
Another country, which used to have an NHS like approach (Covert rationing by area and Post Code) has changed and for the last 20 years has controlled its costs much more effectively, whilst encouraging autonomy for high volume low cost items. This is New Zealand and this perspective by W. Edgar, director of the NZ National Health Committee makes the process overt. Discussion in journals such as Law Medicine and Ethics has also been interesting.
Is it time to look abroad (The Times) for new models?
Holland has an insurance based system with obligatory state cover for those without means.
Germany has a tiered insurance system.
Australia as New Zealand has a mixed service with co-payments for entry.
Canada’s system is based on the NHS but has a method of fiscal transfers (Health Canada is not responsible for the funding of Canada’s health care system. The federal government provides funding to the provinces and territories for health care services through fiscal transfers.)
The USA is a complex picture of mainly private provision (for adults) and state provision newly agreed for children under Mr Obama. Improvements in child and perinatal mortality and morbidity are inevitable, and so opponents are going to do everything they can to sabotage before the same improvements we had in the UK are universal in the USA. Proof figures should come out in 2-3 years time… Meanwhile Wikipedia is the best site I have found for US heath care. Try the official US government portal, but remember you will not be covered unless you take out special insurance for a visit.
A comparison between US and Canada is also available on Wikipedia.
The Irish Medical System has two leveover depending on means. The Irish dont try to pretend that everyone will have an equal service and so they ration healthcare effectively. Wikpiedia gives a non biased account.
Examples of rationing.
- Infertility treatment access differs in different regions.
- Obesity surgery indicators differ in different regions.
- Prescription charges.
Cancer treatment. In most European countries a diagnosis of Cancer prostate would invoke an immediate referral for radiotherapy if that was part of the treatment of choice. Even in low grade prostate cancer, the reassurance that treatment is not delayed is helpful to the patient however here is an example of the information which is provided [complete with typo in last line], and when the patient asked the likely waiting time for radiotherapy the answer was “at least 6 months”.