"Reasonable Rationing is must reading for those interested in how to connect theory about fair rationing processes to country-level practices. The five case studies reveal a deep tension between political pressures to accomodate interest group demands and ethically motivated efforts to improve both information and institutional procedures for setting fair limits to care. The authors frame the issues insightfully." - Professor Norman Daniels, Harvard School of Public Health . How are different countries setting priorities for health care? . What role does information and evidence on cost and effectiveness play? . How are institutions contributing to priority setting? . What are the lessons for policy makers? Priority setting in health care is an issue of increasing importance. Choices about the use of health care budgets are inescapable and difficult. A number of countries have sought to strengthen their approach to priority setting by drawing on research-based evidence on the cost and effectiveness of different treatments. This book brings together leading experts in the field to summarize and analyse the experience of priority setting in five countries: Canada, The Netherlands, New Zealand, Norway and the United Kingdom. Drawing on literature from a range of disciplines, it makes a significant contribution to the debate on the role of information and institutions in priority setting. Reasonable Rationing has been written with a broad readership in mind. It will be of interest to policy makers, health care professionals and health service managers, as well as students of health and social policy at advanced undergraduate and postgraduate levels.

In this book, Philip Rosoff offers a provocative proposal for providing quality healthcare to all Americans and controlling the out-of-control costs that threaten the economy. He argues that rationing--often associated in the public's mind with such negatives as unplugging ventilators, death panels, and socialized medicine--is not a dirty word. A comprehensive, centralized, and fair system of rationing is the best way to distribute the benefits of modern medicine equitably while achieving significant cost savings.

Takahashi reconstructs the key blocks of one of the founders of the institutional school, John R. Commons’ theories of the evolution of capitalism and of institutional change by taking the concept of transaction as a central point of departure. Commons’ theories continue to influence modern economics, and in this book, Takahashi scrutinizes his construction of transaction and its features and offers a reinterpretation of Commons’ institutional economics and transaction economics. He then explores how Commons’ analysis of going concerns (e.g., firms) has broader and deeper applications that extend to monetary policy, labor policy, and the business cycle. Takahashi examines how Commons’ and Veblen’s dynamic theories share cumulative causation. He closes by positing that Commons’ transaction economics seeks “reasonable capitalism” through a virtuous cycle of reasonable value and generation of good business ethics. This book will be attractive to researchers of institutional economics, political economy, heterodox economics, as well as the history of economic thought, law, and ethics.

A rational look at health care rationing, from ethical, economic, psychological, and clinical perspectives. Although managed health care is a hot topic, too few discussions focus on health care rationing--who lives and who dies, death versus dollars. In this book physician and bioethicist Peter A. Ubel argues that physicians, health insurance companies, managed care organizations, and governments need to consider the cost-effectiveness of many new health care technologies. In particular, they need to think about how best to ration health care. Ubel believes that standard medical training should provide physicians with the expertise to decide when to withhold health care from patients. He discusses the moral questions raised by this position, and by health care rationing in general. He incorporates ethical arguments about the appropriate role of cost-effectiveness analysis in health care rationing, empirical research about how the general public wants to ration care, and clinical insights based on his practice of general internal medicine. Straddling the fields of ethics, economics, research psychology, and clinical medicine, he moves the debate forward from whether to ration to how to ration. The discussion is enlivened by actual case studies.

Health systems need to set priorities fairly. In one way or another, part of this important task will fall to physicians. How do they make judgments about resource stewardship, and how should they do so? How can they make such decisions in a manner that is compatible with their clinical duties to patients? In this book, philosophers, bioethicists, physicians, lawyers and health policy experts make the case that priority setting and rationing contribute significantly to the possibility of affordable and fair healthcare and that clinicians play an indispensable role in that process. The book depicts the results of a survey of European physicians about their experiences with rationing and other cost containment strategies, and their perception of scarcity and fairness in their health care systems. Responding to and complementing these findings, commentators discuss why resource allocation and bedside rationing is necessary and justifiable. The book explores how bedside rationing relates to clinical judgments about medical necessity and medical indications, marginal benefits, weak evidence based medicine, off-label use. The book highlights how comparative studies of health care systems can advance more effective and fair bedside rationing through learning from one another. From a practical standpoint, the book offers a number of strategies for health care systems and clinicians to work in tandem to allocate and ration resources as fairly as possible: how to foster more attention to fairness when rationing at the bedside, how to avoid exacerbating health disparities when allocating resources, how to teach about bedside rationing to students, how to discuss rationing more explicitly in the public arena and in the doctor's office.

Health care rationing is a reality in much of the world, and priority setting is an issue of increasing importance. Choices about the use of health care budgets are inescapable and difficult. This study look at priority setting in the health services of several countries.

'Medical need' is a factor in health care access decision-making, but merit-considerations are becoming important too. In the shortening of waiting time, priority arrangements are considered and/or introduced, based on non-medical criteria. Simultaneously, in terms of financing, health status has become important due to payment arrangements, limited insurance package options, etc. At the same time, health status disparities, due to socioeconomic inequalities, seem to be increasing. Under these circumstances, confronted with increased health spending, it is expected that rationing will become more eminent. Due to this, the emerging relevant questions are: Who will be responsible for rationing (the market, governments, bureaucrats, physicians, or others)? * How does it function (explicit or implicit)? * What are relevant and acceptable selection criteria (QUALYs, DALYs, health status, sex, age, etc.)? * To what extent is current rationing just? * What can be done to make it more just? *