The secret art of managing healthcare expenses: investigating implicit rationing and autonomy in public healthcare systems

S M R Lauridsen, M S Norup, P J H Rossel

    Research output: Contribution to journalJournal articleResearchpeer-review

    Abstract

    Rationing healthcare is a difficult task, which includes preventing patients from accessing potentially beneficial treatments. Proponents of implicit rationing argue that politicians cannot resist pressure from strong patient groups for treatments and conclude that physicians should ration without informing patients or the public. The authors subdivide this specific programme of implicit rationing, or "hidden rationing", into local hidden rationing, unsophisticated global hidden rationing and sophisticated global hidden rationing. They evaluate the appropriateness of these methods of rationing from the perspectives of individual and political autonomy and conclude that local hidden rationing and unsophisticated global hidden rationing clearly violate patients' individual autonomy, that is, their right to participate in medical decision-making. While sophisticated global hidden rationing avoids this charge, the authors point out that it nonetheless violates the political autonomy of patients, that is, their right to engage in public affairs as citizens. A defence of any of the forms of hidden rationing is therefore considered to be incompatible with a defence of autonomy.

    Original languageEnglish
    JournalJournal of Medical Ethics
    Volume33
    Issue number12
    Pages (from-to)704-7
    Number of pages4
    ISSN0306-6800
    DOIs
    Publication statusPublished - Dec 2007

    Keywords

    • Decision Making/ethics
    • Health Care Costs
    • Health Care Rationing/ethics
    • Health Services Accessibility/economics
    • Humans
    • Patient Selection/ethics
    • Physician-Patient Relations/ethics

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