The “Ugly Sister of Welfare”: The Idea of Health Care ‘Rationing’ in New Zealand 1968-c.1980

<p>This thesis explores the influence of healthcare ‘rationing’ in New Zealand from 1968 to c.1980. Rationing is a term and concept drawn from health economics and the history of the idea will be traced as well as its influence. The influence of rationing will primarily be explored through case studies: the supply of specialist staff to New Zealand’s public hospitals, the building of hospitals (and specialist units in particular) and the supply of medical technology. This era has been selected for historical examination because of the limited attention paid to it in studies of the health service, and more generally, welfare histories of New Zealand. Often in these studies the 1970s is overshadowed by the period health of reform in the 1980s and 1990s.</p>

The “Ugly Sister of Welfare”: The Idea of Health Care ‘Rationing’ in New Zealand 1968-c.1980

<p>This thesis explores the influence of healthcare ‘rationing’ in New Zealand from 1968 to c.1980. Rationing is a term and concept drawn from health economics and the history of the idea will be traced as well as its influence. The influence of rationing will primarily be explored through case studies: the supply of specialist staff to New Zealand’s public hospitals, the building of hospitals (and specialist units in particular) and the supply of medical technology. This era has been selected for historical examination because of the limited attention paid to it in studies of the health service, and more generally, welfare histories of New Zealand. Often in these studies the 1970s is overshadowed by the period health of reform in the 1980s and 1990s.</p>

Reframing cancer: challenging the discourse on cancer and cancer drugs—a Norwegian perspective

Background As the range of therapeutic options in the field of oncology increases, so too does the strain on health care budgets. The imbalance between what is medically possible and financially feasible is frequently rendered as an issue of tragic choices, giving rise to public controversies around health care rationing. Main body We analyse the Norwegian media discourse on expensive cancer drugs and identify four underlying premises: (1) Cancer drugs are de facto expensive, and one does not and should not question why. (2) Cancer drugs have an indubitable efficacy. (3) Any lifetime gained for a cancer patient is an absolute good, and (4) cancer patients and doctors own the truth about cancer. Applying a principle-based approach, we argue that these premises should be challenged on moral grounds. Within the Norwegian public discourse, however, the premises largely remain unchallenged due to what we find to be unjustified claims of moral superiority. We therefore explore alternative framings of the issue of expensive cancer drugs and discuss their potential to escape the predicament of tragic choices. Conclusions In a media discourse that has seemingly stagnated, awareness of the framings within it is necessary in order to challenge the current tragic choices predicament the discourse finds itself in. In order to allow for a discourse not solely concerned with the issue of tragic choices, the premises that underlie it must be subjected to critical examination. As the field of oncology advances rapidly, we depend on a discussion of its opportunities and challenges that is meaningful, and that soberly addresses the future of cancer care—both its potential and its limits.

A decision support system to solve the problem of health care priority-setting

Purpose The purpose of this study is to provide a decision support tool to deal with the problem of seting priorites among patients competing for limited health care resources. Limited resources and unlimited demands prevent health-care services to be provided to all those in need. This became publicity evident with the current Covid-19 pandemic. Although controversial, health care rationing has always existed and is now inevitable. Setting priorities becomes then inevitable. How to define those priorities is a complex and yet irresolvable issue mainly because it involves several and conflicting criteria, translated into efficiency and equity considerations. This is why multi-criteria decision analysis (MCDA) was introduced to health care as an appropriate decision-support framework for solving complex problems. Design/methodology/approach This paper proposes the application of two combined approaches – analytic hierarchy process (AHP)-Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) and AHP-VlseKriterijumska Optimizacija I Kompromisno Resenje (VIKOR), as decision support tools to rank patients with competing needs in a more effective and equitable way. A rationing scenario involving four patients, differentiated by personal characteristics and health conditions, is used to illustrate, test and compare the applicability of both approaches. After extraction of the relative weights of the prioritization criteria involved in the hypothetical scenario from paired wise comparison methods, TOPSIS and VIKOR priority setting methods were designed. Findings Results suggest that patients ranking from both combination approaches are similar and in accordance with the order made directly by health-care professionals. Therefore, the relative weights computed by AHP in combination with TOPSIS and/or VIKOR methods could be used with suitable applicability by health-care decision-makers. Originality/value This study is the first attempt to apply a combination of MCDA methods to patients’ prioritization context and the first to cross previous studies to deepen and consolidate the research.

An idea alien to both worlds: why health care rationing is not acceptable in the USA and Russia

The simple idea of rationing appears unacceptable both for the relatively poor "socialist" health care in Russia and for the most expensive USA health care. In Russia the idea of rationing is unacceptable, because the Constitution promises free and unlimited medical care. Therefore, discussion is blocked from the top. In the USA the idea is unacceptable, because citizens are understood as having the right to free choice of legal access to any care, without intervention of a 'death jury'.<br/> We analyse the similarities and differences in the arguments rejecting explicit rationing in health care in the USA and Russia. We describe the legal framework in Russia related to rationing, and the results of a qualitative study of the understanding of the concept of rationing by Russian doctors and of the practices in Russian health care organizations to limit the use of expensive diagnostic and treatment options.<br/> While the Russian Constitution promises free medical care, unlimited, legally there are limits imposed by the quota of specific treatments, limited access to care abroad, and problematic access to drugs not included on the essential drug list for inpatient care. Explicit rationing is not rejected by society or by the medical profession. In medical organizations the more explicit techniques are a second opinion by a committee (physicians' commission), especially in the case of prescription of drugs and diagnostic tests. Physicians tend to behave as medical professionals do: provide more care to people in greater need.

Health care rationing in Italy: right to health vs. budget constraints in a regional-based health system

After the enactment of the 2001 Constitutional Reform Act, the Italian health system consists of as many as 21 regional health systems. The central government retains the public task of ensuring that all citizens, regardless of their territorial residence, may access the same universal and equitable health services and provisions.<br/> After the economic crisis of 2007/2008, as has been the case in many other EU MSs, the Italian central government has decreased public expenditure on health care. Not only has such an approach undermined citizens' fundemental right to health. It has also triggered a fierce confrontation between regional governments and the State, which has also been the object of some rulings of the Italian Supreme Court.<br/> Against this background, the paper aims to analyse the impacts that health care rationing has on the organisation of health and care services and on the evolution of social enterprises as health providers.