Is Rationing an Option for Approaching Healthcare Services Provision? the Case of the Greek Cardiac Patients
Fafaliou, Irene, Tzanalaridou, Euthalia, Ballas, Apostolos, International Advances in Economic Research
Abstract This paper attempts to address some of the issues surrounding rationing of healthcare services, with application to Greece's delivery of cardiac services. To this end, first, we provide highlights of the current debate concerning rationing worldwide and critically discuss them. Following that, an empirical analysis of the way 'key' stakeholders perceive rationing issues in Greece, is performed. Findings indicate that rationing is a highly disputed approach, subject to individualistic interpretations and moral issues. At policy level, it becomes evident that rationing is a mixture rather than a single policy concern, depending on a complicated range of locally-based reconciliation made at various levels of interested parties. Hence, no universal formula exists to fit all countries' healthcare systems and further case-by-case research, is required.
Keywords Rationing decision * Priority setting * Healthcare * Health policy making * Greek cardiac stakeholders
The Issue in Context
The rising cost of healthcare services combined with the ever increasing problems in public financing worldwide, have recently led to reconsideration of rationing as a convenient method for cost savings in healthcare delivery (OECD 2008). Despite the theoretical justification of such concerns, however, there is no consensus in the field concerning the way and the extent to which rationing impacts patients' care (see for e.g. Klein and Williams 2000).
In practical terms, though several countries across the globe, such as the U.K., Canada, Sweden, Holland, Denmark, Norway, New Zealand and Israel, have implicitly or explicitly applied rationing in healthcare delivery, no valid estimation has been reached so far concerning the impact of such measures (Sabik and Lie 2008). Differences in outcomes are often discussed in the literature as reflecting differences in rationing perceptions, the methods employed and assumptions involved, as well as what rationing entails.
According to Cooper (1995), though 'rationing', 'cost containment' and 'priority setting' are not identical terms, they all finally address the same issues: 'how much of a certain healthcare service will be provided', 'to whom', 'at what cost' and 'under what circumstances'. For New (1996), rationing can be defined in terms of methods used. These are, namely: (a) the exclusion or denial of a service and (b) the withholding of a potentially beneficial treatment, without the patient's consent. In line with New, Mechanic (1997), points out the abundance of rationing tactics that can be used to implicitly control costs and determine whether a service delivery is required. These are, the following: queuing, reducing the intensity of services, and substituting less expensive for more costly services. All in all, it seems that there is a lack of a common understanding of 'who makes the decisions (or instructions) to the healthcare providers', 'how patients feel about rationing' and, most significantly, 'what is the effect on patients' care'.
The existing confusion in the field as well as the small number of locally-based surveys in micro environments constitute a great challenge for the authors of this paper to investigate the issue further, with application to a Greek context for the first time in Greece's Healthcare history. Our scope is not to generalize outcomes to a wider population but to enrich the existing theoretical knowledge (Mason 2002) by bringing into sight the awareness, attitudes, views and experience of a sample of Greek stakeholders, on major rationing issues.
This paper attempts to address some of the limitations of the existing work by providing a better understanding of the way locally-based stakeholders perceive rationing and its characteristics, as well as the impact of alternative rationing methods on patients' care. To this end, first, we open up a discussion concerning a few core and complex themes involved in rationing debate and, then, we perform an empirical case study analysis to explore Greece's delivery of cardiac services. …