Healthcare Rationing: Medicine, Markets and Morals

SPH LW 709

Although health care is rationed in a variety of ways in the United States, Americans, and American politicians in particular, make believe that rationing does not exist. Indeed, efforts at health care reform have often been criticized for leading to "rationing' health care resources, implying that rationing is something evil. The idea that all Americans get the health care they need or that we have limitless resources is obviously not so. What health care is available and to whom is the result of the often invisible choices policy makers make. This course critically explores the health care allocation choices that have been made and will be made in the future. It analyzes the advantages and disadvantages of various rationing methods, the values and moral judgments reflected in each, and the political and financial factors influencing the choice of approach, as well as who should make such choices. Examples of rationing to be discussed include the distribution of organs for transplantation, determining what constitutes "necessary" care under insurance schemes, the use of markets and lotteries as rationing methods, limitations on population screening, the use of age and "social worth" to limit health care to individuals, triage in emergencies, and the utility (or disutility) of cost-benefit analysis for making decisions about the availability and distribution of health care. By the end of the course, students will be able to articulate the range of possible rationing methods and to appropriately apply these methods to different scarce resource circumstances.

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