Tomorrow's health care administrators will need to assess the problem surrounding the inevitable rationing of health care to an American society which already prides itself on receiving the best medical care in the world. If medical care rationing is to be implemented successfully, administrators will need to adhere to one of the preliminary principles of the Hippocratic Oath: "First, do the patient no harm." This will entail careful planning and follow-up so that the quality of future care is not sacrificed in our attempt to more fairly allocate resources.
The American health care system rations care already, even though most people do not like to use the word. "Rationing" implies that some will have to do with less, in the greater interest of all. Rationing is the distribution of resources to services or individuals according to rules based on one or more of the following: personal characteristics, disease status, cost of intervention, and outcomes. Additionally, the act of rationing has an ethical component; it is not just a matter of value-free economics. Dictionaries define rationing not simply as denying something--which would reasonably make it a fearful term in health care discussions--but as distributing equally or equitably some commodity or resource in scarce supply.
In this country, access to quality health care is available to those who have insurance, either because their employers provide it, or because they can afford to purchase it independently. However, the United States faces a serious problem that promises to get worse: the inability of many residents to gain access to health care, primarily because of cost. Patrick and Erickson state the problem in socioeconomic terms: "Although geographic, cultural, and educational barriers limit access to care, financial barriers dominate. Poor people, near-poor people, and persons with chronic illness--especially those without public or private insurance--f...