by Dr.Arun K. Tiwari There are two concepts of rationing in healthcare- Conventional Rationing and Price-based Rationing.
Concept of Conventional Rationing can be animated in the function of a sand clock where scarce resource from upper half passes down through a narrow channel and gets distributed to a large base. Similarly price based rationing can be visualized in the form of a coin box telephone, where only those get to make calls who are capable of inserting coin and also in order to maintain it, they are required to keep pushing the coins.
Question regarding which type of rationing seems to be settled in favor of the conventional rationing as it is less offending towards human rights (consider emergency cases being denied for not being able to pay). Looking at various health systems across the world, Rationing is evident in various forms e.g. waiting time, exclusion of drugs from list, gate keeping or even complete denial of services like cosmetic surgeries and dentistry.
Though healthcare sector strives hard to achieve cost minimization, it becomes difficult because of two major reasons: shortage of skilled professionals, which drives the cost of labor high and second, using finished products from other sciences (e.g technology, IT, pharmaceuticals etc) as inputs to produce services, which causes a second level of cost escalation.
Nonetheless, the health systems have their own ways of reducing cost. Primary Health Care (based on the principles of equitable distribution, Community participation, inter-sectoral co ordination and appropriate technology) is the most suited low cost model advocated for most developing countries by WHO. Other prevalent approaches are those of QALY and DALY. It is out of these principles of allocative efficiency that the concept of rationing derives most of its rationality. Development of innovative financing mechanisms to mitigate the risk of catastrophic expenditure during illness is an example of expanded rationality.
There are policies in which rationing is implicitly expressed (such as NHS, UK) and in some others, it is explicit (USA). Market based or non market based means- Rationing as a policy tool seems ubiquitous in all health systems. Interestingly this happens to be the most basic of all tools known to deal with scarcity of resources.
Thus, more than the matter of its presence, it is the form of presence which ought to be subjected to debate. It is now a debate of means and methods by which this particular policy tool is used rather than the rationality and validity of the tool itself.
