Health care rationing
Health care rationing refers to the practice of limiting access to medical care due to insufficient resources or funding, affecting who receives treatment and at what point. This can arise in various health care systems, including government-run programs and free market systems like that of the United States. Rationing typically occurs when the demand for medical services exceeds the available supply, prompting decisions about how to prioritize care. Common examples include insurance policies that impose prior authorizations, annual visit limits, or high deductibles, which can restrict access based on financial considerations. Rising health care costs, driven by new technologies, increased demand, and the complexities of emergency care provision, have intensified concerns about rationing. Critics often associate rationing with government health care systems, fearing bureaucratic decisions may deny care to vulnerable populations. Conversely, proponents argue that current forms of rationing in private health systems also impact access, effectively raising the question of equity in health care delivery. The ongoing debate about health care reform, including universal coverage, continues to highlight the challenges of balancing cost, access, and quality of care.
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Health care rationing
Health care rationing is the practice of restricting the amount or level of medical care available to a person or group of people. It is most often thought of in terms of government-run programs that refuse to allow certain procedures or treatments for some or all of the people it covers. However, experts say that health care rationing occurs in many forms and in nearly every health care system, including a free market system like the one in the United States.
Background
Rationing is a practice that calculates how far an available service or item will go and makes rules about how to distribute it. It is usually implemented when there is greater demand for something than there is supply. For example, during World War II (1939–1945), food items such as sugar, meat, and butter were rationed as was gasoline. These items were needed to provide for American soldiers and those directly affected by the war overseas, so the government limited how much people in America could purchase to make sure everyone got something and no one had significantly more than anyone else did.
There can also be more need for health care than there are available services or supplies. This is often the case in underdeveloped countries, where people may live in remote areas with few or no advanced medical services available. In these areas, people may die or suffer unnecessarily because doctors and hospitals are not available. Yet, this is not considered health care rationing because the care is not available at all, and it is not being restricted intentionally.
Health care rationing usually refers to situations in which health care is available but is limited for some reason. In health care rationing, the care is usually available, but the funds to pay for it are not. This leads to restrictions on who can get care, when they can get it, or what care is accessible based on the amount of money available to pay for it. Care can also be restricted so that the available pool of money can be directed toward services thought to provide greater benefits or a higher chance of success.
As health are costs have increased, rationing has become more of a concern. Many factors have contributed to rising health care costs. New technologies, procedures, and pharmaceuticals contribute to higher costs because they are often more expensive. Health care providers seek to charge more to cover the cost of adopting new technologies and providing up-to-date facilities. These providers must also cover the increasing costs of malpractice insurance and the potential costs of any lawsuits. Hospitals are required to provide emergency care to people even if they are uninsured, and these costs contribute to the overhead costs paid by everyone.
Increased demand is another reason for increased costs. As people become aware of new ways to improve their health, they tend to seek more care. Increased health care screenings can identify conditions earlier, leading to more treatments. People are also living longer, increasing the number of individuals who need care for age-related conditions.
Many of these issues are not bad in and of themselves, but they do contribute to rising costs. In the United States, this has resulted in increased premiums, copays, and deductibles for people with insurance. Rising costs have also led to lower reimbursement rates for physicians and facilities from government plans such as Medicare and Medicaid, programs that help pay for health care for the elderly, disabled people, low-income people, and others. In countries with government-run health plans, rising costs increase the taxes paid by citizens or cause the country to incur greater debt to pay for health care costs.
In the 2010s and 2020s, pharmaceutical companies were criticized for charging US patients excessively high prices for commonly used and often life-saving prescription drugs. One such pharmaceutical is insulin, which is used to treat diabetes. In the United States, over 38 million people have diabetes. Of these, 8.4 million people with Type 1 diabetes depend on insulin to live, while some patients with Type 2 diabetes use insulin to manage their diabetes. Studies of insulin prices in 2018 showed that while it cost between $2 and $4 to make a vial of insulin, the average price of a standard unit of insulin in the US was $99, compared to $8.81 in other high-income nations. Such price gouging, combined with a lack of adequate insurance coverage, led 1.3 million US diabetics to ration their insulin doses in 2021. Some states responded to insulin rationing by capping patient co-payments on insulin and other devices and supplies used to manage diabetes. On the federal level, President Joe Biden and his administration took steps to address high prescription drug costs through the Inflation Reduction Act of 2022, which allowed Medicare to negotiate directly with pharmaceutical companies starting in 2023 and reduced the amount that Medicare patients paid out of pocket for insulin to $35 per month. In 2023, Eli Lilly announced that it would match Medicare's cap on insulin costs and offer the same pricing to commercially insured and uninsured patients.
Overview
The idea of health care rationing often prompts angry reactions from people who envision government bureaucrats denying care to the elderly, the disabled, or other populations. It is often thought of in the context of single-payer government-run health plans like those in Canada and the United Kingdom, where bureaucrats decide what procedures will be covered and how many people will get them, leaving some people waiting or going without care. Rationing is often cited as an argument against universal health care, where all citizens of a country have coverage.
However, experts say that health care is rationed in many ways in nearly every health care system, including a free market system like the one in the United States. They say insurers that require prior authorization before allowing certain procedures or services are practicing a form of rationing when they only allow those who have met specific requirements to get these services. This is usually done not because the services or procedures have limited availability, but because they are expensive and either diminish profits or use more of the resources available to provide care to others. Annual or lifetime maximums are another form of rationing; some insurance plans only allow a certain number of visits for mental health, physical therapy, and other services or place dollar limits on the amount of durable medical equipment provided.
The cost of health care produces other forms of rationing, some experts say. High deductibles, where people have to pay for a certain amount of their health care before their insurance begins covering services, can prevent people from getting care they might need. High-deductible insurance policies are less expensive, which means the people who purchase them may have lower incomes and may have trouble paying for care until the deductible is met. This serves to ration care, though the rationing is indirect.
Some experts contend that there are other indirect forms of rationing as well. They claim that current government programs that cover people of certain ages or circumstances are rationing care by putting the priorities of those groups above others. This would include programs such as Medicare, Medicaid, and the Children's Health Insurance Program (CHIP).
Health care rationing is a key aspect in the debate over universal or single-payer government-backed health care and health care policy and reform at large. People who oppose these programs often do so on the grounds that they will lead to rationing, where people cannot have the care they and their doctors think they need. Others believe that this type of rationing is better than the indirect rationing already in place in free market systems, where a person's income can serve as a form of rationing by limiting access to health care.
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