MSN 202
Advanced Health Care Economics with Entrepreneurship in Nursing
Healthcare
Rationing
What is healthcare rationing?
▫ There is no universal definition of
the word ‘rationing’. Fourteen
definitions of rationing were elicited
from the literature
2
3 Important notions that constitute
the definition of healthcare
rationing:
▫ Scarcity
▫ resource constraint,
▫ exclusion
3
▫ Decision-making by healthcare
workers is based on:
▪ who needs the resource most
▪ which treatment has the
maximum benefit or outcome to
society/population
▪ which is cost effective
4
“
“restricting the access of some
people to useful or potentially
useful health services due to
budgetary limitation”.
5
Why health services
must be rationed?
Determinants
of
Rationing
▫
▫
▫
Scarcity
Value
Controllability
7
Trend of
Health Services
Rationing
▫
▫
▫
Implicit, hidden
nonsystematic
“explicit and
open systematic
8
Who does the
healthcare
Rationing?
Health
Systems
Intermediate
Clinical Level
Mechanic
(1997)
9
Who does the
healthcare
Rationing?
Macro-allocation
Health
Systems
Meso-allocation
Intermediate
Clinical Level
Micro-allocation
Klein
(1997)
10
Who does the
healthcare
Rationing?
Political Level
Clinical Level
Krizova and Simek
(2002)
11
Who does the
healthcare
Rationing?
Across whole services
Across treatments within services
Within treatments
Between individual patients
Coast et. Al
(1996)
12
Who does the
healthcare
Rationing?
Policy Makers
Managers
Providers
Patients
Coast et. Al
(1996)
13
Nurse & Doctor’s Role
CODE OF
ETHICS
Nurses
American Nurses Association
Code of Ethics- Provision 1
▫ “The nurse, in all professional relationships,
practices with compassion and respect for the
inherent dignity, worth, and uniqueness of
every individual, unrestricted by considerations
of social or economic status, personal
attributes, or the nature of health problems.”
15
CODE OF
ETHICS
Nurses
PRC Board Resolution No. 220 9 (Series of 2004)
Promulgation of the Code of Ethics for
Registered Nurses
Section 1, Article 1
▫ “Health is a fundamental right of every
individual. The Filipino Registered Nurses
believing in the worth and dignity of each
human being, recognizes the primary
responsibility to preserve health at all cost.”
16
CODE OF
ETHICS
Doctors
American Medical Association
Code of Medical Ethics
Opinion 2.03 -Allocation of Limited Medical Resources
▫ “A physician has a duty to do all that he or she can for the
benefit of the individual patient. Policies for allocating limited
resources have the potential to limit the ability of physicians to
fulfill this obligation to patients. Physicians have a
responsibility to participate and to contribute their
professional expertise in order to safeguard the interests of
patients in decisions made at the societal level regarding the
allocation or rationing of health resources. Decisions regarding
the allocation of limited medical resources among patients
should consider only ethically appropriate criteria relating to
medical need.”
17
CODE OF
ETHICS
Doctors
PRC Board Resolution No. 29 9 (Series of 2019)
Revised Code of Ethics of the Medical Profession
Section 1, Article 1
▫ “Principle of social justice. All patients have a
right to basic healthcare and a just process in
the allocation of resources. .”
18
Healthcare Rationing
During a COVID-19
Thank you!