Can We Say No?: The Challenge of Rationing Health Care Review

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(More customer reviews)This is a topic that should get more attention than it does. Increased rationing of health care is coming, no matter how much we want to wish it away. Aaron and Schwartz deserve credit adding to the, so far limited, discussion on the topic.
The book is largely a comparison of the provision of certain services in the United States and Britain. The British National Health Service was established after World War II and it generally holds down costs by establishing global budgets and requiring providers to operate within them. This method is likened to managed care by some. The British system has much lower use of services such as dialysis and fewer intensive care beds, even after adjusting for population differences. Given lower capacity in some areas, the British have to been much choosier about who receives care in these areas.
The British system of rationing was largely unregulated, in the sense there was not often a uniform criteria for choosing one patient over another. Rather providers were obliged to simply make do within their budgets and this helped create a "culture" of care provision that differs from the culture in the United States. Beginning in the 1980s, technological advancements and increased expenditures in some of the most heavily rationed areas, such as dialysis, greatly increased the capacity to provide care although rates of treatment are still far lower than in the U.S.
The authors suggest it might be wise for the U.S. to copy some aspects of the British system to help hold down costs. However, they acknowledge there are some significant differences, such as an American legal system that gives deference to demands for care.


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