Health Care Rationing

Oldie but a goodie..


http://www.ncpa.org/w/w50.html

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Excerpted From:
John C. Goodman and Gerald L. Musgrave
Patient Power (Washington, DC: Cato Institute, 1992)
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Health Care Rationing
Because we could in principle spend many times our gross national product on health care, it must be rationed in some way. The primary way in which it is rationed in the United States is by individual choice. When the expected cost of medical care exceeds its expected benefit, people forego it. For example, some people choose self-medication with nonprescription drugs. What deters them from going to the doctor’s office every time is the physician’s fee, the time cost, the travel cost, lost wages, and other inconveniences. If everyone who purchased nonprescription drugs saw a physician instead, the United States would need 25 times the current number of physicians.
For years, advocates of a government-run health care system have argued that all health care should be free at the point of consumption and that it is unfair (and perhaps also unwise) to ask people to compare the value of health care with the cost of getting it. But if health care were made absolutely costless, the system that provides it would collapse into chaos. Thus, even in countries such as Britain and Canada where health care is theoretically free, people are deterred by other costs (including waiting costs) and an enormous amount of self-rationing goes on.

The alternative to self-rationing is bureaucratic rationing. For example, many large companies are seeking ways to deter health care spending. Most are opting for bureaucratic solutions. But at least one company, Hewlett Packard, announced a plan in 1990 that explicitly calls for employee rationing by choice. The plan involves giving patients more information, encouraging choices between money and medical care, and using physicians as "patient advisers rather than technicians or deliverers of care." Since that time, a number of employers have created Medical Savings Accounts for their employees. Until recently, rationing by bureaucracy in the private sector was rare, confined largely to organ transplants and occasional triage situations in hospitals. Rationing is more frequent in the public sector and is increasing in the Medicare and Medicaid programs.

Outside the United States, every country that has national health insurance rations health care through bureaucracies. It is almost never done through open rational debate. Instead, politicians limit the budgets of hospitals or of area health authorities and leave rationing decisions to the health care bureaucracy. Indeed, politicians almost never admit that they are in any way responsible for rationing.

Among the characteristics of health care rationing as practiced in other developed countries are the following. If health care is rationed by bureaucracies, the tendency is to discriminate in favor of higher-income patients, in favor of whites (especially male whites), and in favor of the young. The sophisticated, the wealthy, and the powerful almost always find their way to the head of rationing lines. Whereas markets empower individuals, bureaucracies empower special interests.

Rationing decisions in the United States appear to be no different. Studies have discovered that, when transplants are rationed, bureaucracies appear to discriminate on the basis of income, race, and sex. For example, a study by the Urban Institute found that, for black and white males, the higher their income, the more likely they are to receive an organ transplant. In 1988, according to the United Network for Organ Sharing, whites received 97.6 percent of the pancreases and high percentages of livers, kidneys, and hearts; and men received 79.2 percent of hearts, 60.6 percent of kidneys, and 54.4 percent of pancreases. According to the American Society of Transplant Physicians, although the rate of end-stage renal disease is four times higher among blacks than among whites, blacks constitute 28 percent of the kidney patients and receive only 21 percent of the kidney transplants. The Pittsburgh Press found that if the donors were not living relatives, the average wait for a kidney transplant in 1988 and 1989 was 14 months for black patients and only 8.8 months for whites.

In the United States, the elderly have a privileged position with respect to health care. Medicare covers virtually all of them, plus people under 65 who are disabled. But in other countries, where the entire population is part of the same government-funded health care plan, the elderly are usually pushed to the end of the rationing lines. Thus, in Britain, it is extremely difficult for an elderly patient to get kidney dialysis or a kidney transplant - or any other transplant, for that matter. Moreover, pressures that have developed in other countries are developing in our own. Former Colorado governor Richard Lamm and other prominent individuals (including "medical ethicists") are calling for rationing health care to the elderly and reallocating the funds to the younger population.

Until a few years ago, most health policy analysts did not believe in health care rationing. Their goal was to lower all financial barriers through public and private insurance and to meet any and all needs. Today, almost everyone recognizes that rationing is necessary. The all too often tendency, however, is to believe that rationing discussions should be controlled by health care bureaucracies and not by individual patients.

In an ideal system, rationing would be by patient choice wherever possible. The system would be organized so that people would have the funds necessary to purchase health care through medical savings and reimbursements from insurers. But people would have strong incentives not to purchase health care unless the expected value of the care were greater than the monetary costs. Patients, of course, could consult their physicians. But the power of choice would be in the hands of the patients, not the bureaucrats.

Granny victim of colostomy confusion

A German woman went into the hospital for a leg operation and came out with a colostomy. Gotta love that socialized medicine.

Published: 14 Mar 08 14:48 CET
Online: http://www.thelocal.de/10695/

German authorities said on Friday they are investigating an incident medical of malpractice involving an elderly woman in Bavaria, who has mistakenly received a colostomy instead of a leg operation.

The Friday edition of local daily Frankenpost reported a 78-year-old woman in the Bavarian town of Münchberg has been the victim of an operating table mix-up.

On February 29, the woman mistakenly underwent a colostomy procedure instead of a leg operation, the paper reported. Members of medical team involved in the incident have since been suspended from their duties. According to Frankenpost, two of these doctors were chief physicians.

A hospital official said the facility regrets the mistake, and reacted to the mix-up immediately by notifying the patient, her relatives, and the appropriate authorities.