A clearly written and well structured textbook, providing an introduction to decision making and priority setting, this title brings together theories, practice and evidence from a wide range of disciplines.
The 2010 Affordable Care Act is a sweeping reform to the US health care system. Hoffman offers an engaging and in-depth look at America's long tradition of unequal access to health care. She argues that two main features have characterized the US health system: a refusal to adopt a right to care and a particularly American type of rationing. Unlike rationing in most countries, which is intended to keep costs down, rationing in the United States has actually led to increased costs, resulting in the most expensive health care system in the world.
Should organ transplants be given to patients who have waited the longest, or need it most urgently, or those whose survival prospects are the best? The rationing of health care is universal and inevitable, taking place in poor and affluent countries, in publicly funded and private health care systems. Someone must budget for as well as dispense health care whilst aging populations severely stretch the availability of resources. The Ethics of Health Care Rationing is a clear and much-needed introduction to this increasingly important topic, considering and assessing the major ethical problems and dilemmas about the allocation, scarcity and rationing of health care. Beginning with a helpful overview of why rationing is an ethical problem, the authors examine the following key topics: What is the value of health? How can it be measured? What does it mean that a treatment is "good value for money"? What sort of distributive principles - utilitarian, egalitarian or prioritarian - should we rely on when thinking about health care rationing? Does rationing health care unfairly discriminate against the elderly and people with disabilities? Should patients be held responsible for their health? Why does the debate on responsibility for health lead to issues about socioeconomic status and social inequality? Throughout the book, examples from the US, UK and other countries are used to illustrate the ethical issues at stake. Additional features such as chapter summaries, annotated further reading and discussion questions make this an ideal starting point for students new to the subject, not only in philosophy but also in closely related fields such as politics, health economics, public health, medicine, nursing and social work.
'Medical need' is a factor in health care access decision-making, but merit-considerations are becoming important too. In the shortening of waiting time, priority arrangements are considered and/or introduced, based on non-medical criteria. Simultaneously, in terms of financing, health status has become important due to payment arrangements, limited insurance package options, etc. At the same time, health status disparities, due to socioeconomic inequalities, seem to be increasing. Under these circumstances, confronted with increased health spending, it is expected that rationing will become more eminent. Due to this, the emerging relevant questions are: Who will be responsible for rationing (the market, governments, bureaucrats, physicians, or others)? * How does it function (explicit or implicit)? * What are relevant and acceptable selection criteria (QUALYs, DALYs, health status, sex, age, etc.)? * To what extent is current rationing just? * What can be done to make it more just? *
A rational look at health care rationing, from ethical, economic, psychological, and clinical perspectives. Although managed health care is a hot topic, too few discussions focus on health care rationing--who lives and who dies, death versus dollars. In this book physician and bioethicist Peter A. Ubel argues that physicians, health insurance companies, managed care organizations, and governments need to consider the cost-effectiveness of many new health care technologies. In particular, they need to think about how best to ration health care. Ubel believes that standard medical training should provide physicians with the expertise to decide when to withhold health care from patients. He discusses the moral questions raised by this position, and by health care rationing in general. He incorporates ethical arguments about the appropriate role of cost-effectiveness analysis in health care rationing, empirical research about how the general public wants to ration care, and clinical insights based on his practice of general internal medicine. Straddling the fields of ethics, economics, research psychology, and clinical medicine, he moves the debate forward from whether to ration to how to ration. The discussion is enlivened by actual case studies.
This book reveals how economic restrictions and limited healthcare resources, combined with growing care demands due to advanced technology and more care options, have to a great extent contributed to increased workloads for healthcare professionals and put them under pressure to prioritize their work. This has led to the rationing of care, i.e., to decision-making processes on the allocation of scarce resources, especially human resources, and on which care activities take priority over others; in turn, these processes have led to unfinished or missed care, which has serious implications for quality of care and patient safety. Concerns related to nursing shortages and lean staffing practices have increased the awareness of the problem, as patient outcomes are affected by the quality and quantity of care that they receive and led to intensified scientific inquiry into this phenomenon. This book is written by the members of the Rancare Cost Action group, whose aim is to facilitate discussion about rationing of nursing care based on a cross-national comparative approach with implications for practice and professional development. Four working groups investigated four areas for four years: a) the conceptualization of care rationing and methodological inquiries concerning the investigation of the phenomenon, b) exploration of possible solutions and intervention studies, c) the ethical perspective of care rationing and missed care including patients’ rights and possible discrimination, and d) the educational implications, based on an exploration of the level of patient safety training and care rationing, as well as preparing guidelines for managers. The book will be a valuable resource for nurses, allied healthcare professionals, managers, policymakers, researchers, ethical committees, and educators whose goal is to provide better and safer care.
Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received. In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients' and providers' attitudes, expectations, and behavior are analyzed. How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider-patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.
Mandatory food rationing during World War II significantly challenged the image of the United States as a land of plenty and collapsed the boundaries between women's public and private lives by declaring home production and consumption to be political activities. Examining the food-related propaganda surrounding rationing, Eating for Victory decodes the dual message purveyed by the government and the media: while mandatory rationing was necessary to provide food for U.S. and Allied troops overseas, women on the home front were also "required" to provide their families with nutritious food. Amy Bentley reveals the role of the Wartime Homemaker as a pivotal component not only of World War II but also of the development of the United States into a superpower.