Diss week 4 DDHA 8600
Health Services Rationing
Health services rationing means restricting the access of some people to useful or
potentially useful health services due to budgetary limitations (Scheunemann, & White, 2011).
Rationing can be applied in four levels: health care policymakers, health care managers, health
care providers, and patients. Health care rationing can be accomplished through a fixed budget, a
benefits package, payment mechanisms, queuing, copayments, and deductibles (Keliddar, et al.,
2017).
Example of Rationing
Politicians, policymakers, and health insurance companies at the macro- level set some
rules and regulations about the allocated health care budget, services coverage, and cost-sharing
mechanisms considering political, economic, social, and technological factors. Policymakers and
authorities at the macro- level can use methods such as budget, a benefits package, and payment
mechanisms to control the behavior of health care managers and providers, thus restricting a
wide variety of inappropriate health services.
Impact on Healthcare Organization
Health services coverage is sometimes limited through the specification of a menu of
core health care services. Clinical guidelines assist practitioners on which diagnostic tests to
order, how to provide surgical, medical, and nursing facilities, and how long patients should stay
in the hospital (Saarni, 2004). At my health Organization, many senior patients are impacted by
"donut hole" as know they are limited in the amount they can spend on prescriptions because if
they spend more, it comes from their own pockets. This is further impacted in my department
when we are presenting a Clinical Trial to a cancer patient, as many of the major questions are
centered regarding what insurance will cover and what the study sponsor will be covering. Of
course, the goal is to provide the patient access to new promising treatments and that the
financial burden is not meant to be placed on the patient.
References
Keliddar, I., Mosadeghrad, A., & Jafari-Sirizi, M. (2017). Rationing in health systems: A critical
review. Medical Journal Of The Islamic Republic Of Iran, 31(1), 271-277.
https://doi.org/10.14196/mjiri.31.47
Saarni, S. (2004). Evidence based medicine guidelines: a solution to rationing or politics
disguised as science?. Journal Of Medical Ethics, 30(2), 171-175
https://doi.org/10.1136/jme.2003.003145
Scheunemann, L., & White, D. (2011). The Ethics and Reality of Rationing in
Medicine. Chest, 140(6), 1625-1632. https://doi.org/10.1378/chest.11-0622
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5804460/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415127/