Health costs are escalating and rationing of health care has become a focus. Many believe it is inevitable and others still argue against it. Confusion exists regarding the definition of rationing; it is argued that limitations have always existed within the health care system. If rationing does exist, the question to explore then becomes what and how.
The American health care system is expensive and getting more so; by 1993 expenditures climbed to approximately 14 percent of the gross national product. The system consumes resources disproportionate to the value it delivers; about 20 percent is spent on administrative costs and about one third of Medicare dollars are spent on those in the last year of life. The availability of new effective and expensive technology such as magnetic resonance imaging, has helped to increase costs. Insurance systems that encourage overuse and malpractice that encourages the practice of defensive medicine have also raised costs. An aging population adds to health care. The system is faced with cutting costs and continuing to provide access to quality care; the focus is on rationing (Wachter, 1995).
The rising costs of health care result in increased taxes, higher insurance premiums, and decreased business profits. Cost concerns strain the physician-patient relationship; willingness to care for the indigent is lost creating barriers for the poor. The American health care system receives the most advanced care but denies access to basic primary care (Wachter, 1995).
Some believe that the only way to cut costs is to ration, that the only way to make available the necessary resources is to withhold the care we know to be beneficial. Others disagree and state that our society is wealthy and should not ration care; it should cut costs with the elimination of expenditures on useless care. The provider has a dominant role in deciding what health care is available. The consumer is uncerta...