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!