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"Health care rationing"
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Law, legitimacy and the rationing of healthcare : a contextual and comparative perspective
Dr Keith Syrett argues for a reappraisal of the role of public law adjudication in questions of healthcare rationing. As governments worldwide turn to explicit rationing strategies to manage the mismatch between demand for and supply of health services and treatments, disappointed patients and the public have sought to contest the moral authority of bodies making rationing decisions. This has led to the growing involvement of law in this field of public policy. The author argues that, rather than bemoaning this development, those working within the health policy community should recognise the points of confluence between the principles and purposes of public law and the proposals which have been made to address rationing's 'legitimacy problem'. Drawing upon jurisprudence from England, Canada and South Africa, the book evaluates the capacity of courts to establish the conditions for a process of public deliberation from which legitimacy for healthcare rationing may be derived.
eBook
Drawing the line : healthcare rationing and the cutoff problem
Rosoff \"discusses how to decide what should and should not be covered in a generous [health care] benefits plan for all. He considers a variety of ways this might be done and concludes that the most just approach is to utilize a transparent process in which experts and lay people develop a consensus on what should be covered by focusing on both clinical evidence of need and the effective and appropriate means to address those needs. He also considers the various objections and impediments to this proposal and concludes that they are obstacles that can be successfully met\"--Amazon.com.
Book
Systems-level barriers to treatment in a cervical cancer prevention program in Kenya: Several observational studies
To identify health systems-level barriers to treatment for women who screened positive for high-risk human papillomavirus (hrHPV) in a cervical cancer prevention program in Kenya.
In a trial of implementation strategies for hrHPV-based cervical cancer screening in western Kenya in 2018-2019, women underwent hrHPV testing offered through community health campaigns, and women who tested positive were referred to government health facilities for cryotherapy. The current analysis draws on treatment data from this trial, as well as two observational studies that were conducted: 1) periodic assessments of the treatment sites to ascertain availability of resources for treatment and 2) surveys with treatment providers to elicit their views on barriers to care. Bivariate analyses were performed for the site assessment data, and the provider survey data were analyzed descriptively.
Seventeen site assessments were performed across three treatment sites. All three sites reported instances of supply stockouts, two sites reported treatment delays due to lack of supplies, and two sites reported treatment delays due to provider factors. Of the 16 providers surveyed, ten (67%) perceived lack of knowledge of HPV and cervical cancer as the main barrier in women's decision to get treated, and seven (47%) perceived financial barriers for transportation and childcare as the main barrier to accessing treatment. Eight (50%) endorsed that providing treatment free of cost was the greatest facilitator of treatment.
Patient education and financial support to reach treatment are potential areas for intervention to increase rates of hrHPV+ women presenting for treatment. It is also essential to eliminate barriers that prevent treatment of women who present, including ensuring adequate supplies and staff for treatment.
Journal Article
The Relationship Between the Rationing of Nursing Care, Job Satisfaction, and Burnout Among Nurses in Northwestern Poland
Rationing of nursing care, understood as the omission or inadequate performance of professional activities, is a phenomenon observed in medical care facilities around the world. It results not only in the risk of reducing patient trust and satisfaction with the care provided but also in adverse events that can significantly reduce patient safety.
The aim of this study was to search for factors contributing to the rationing of care by Polish nurses.
This survey-based study, which involved 528 nurses from northwestern Poland, was performed in 2023. It was performed using a tool of our own design and three standardized questionnaires: the Basel Extent of Rationing of Nursing Care-Revised (BERNCA-R), the Satisfaction with Job Scale (SWJS), and the Maslach Burnout Inventory (MBI).
The average BERNCA-R score was 1.52 points (SD = 0.95), which indicates a low level of rationing care by the surveyed nurses. Analysis of the SWJS results revealed that the respondents were rather dissatisfied with their work. The MBI confirmed high levels of burnout in all three subscales: emotional exhaustion (58.33%), depersonalization (55.3%), and personal accomplishment (83.5%). Linear regression analysis showed that in both univariate and multivariate models, the MBI emotional exhaustion subscale score, working 12 or 24 h shifts, and caring for a group of 11-20 patients were direct, independent predictors of rationing of nursing care as measured by the BERNCA-R. Job satisfaction, due to its statistical significance verified by multivariate analysis, was an independent predictor (
= 0.004).
The phenomenon of nursing care rationing is associated with increased workload, low job satisfaction, and emotional exhaustion.
Journal Article
Crisis standards of care in a pandemic: navigating the ethical, clinical, psychological and policy-making maelstrom
Abstract
The COVID-19 pandemic has caused clinicians at the frontlines to confront difficult decisions regarding resource allocation, treatment options and ultimately the life-saving measures that must be taken at the point of care. This article addresses the importance of enacting crisis standards of care (CSC) as a policy mechanism to facilitate the shift to population-based medicine. In times of emergencies and crises such as this pandemic, the enactment of CSC enables concrete decisions to be made by governments relating to supply chains, resource allocation and provision of care to maximize societal benefit. This shift from an individual to a population-based societal focus has profound consequences on how clinical decisions are made at the point of care. Failing to enact CSC may have psychological impacts for healthcare providers particularly related to moral distress, through an inability to fully enact individual beliefs (individually focused clinical decisions) which form their moral compass.
Journal Article
The Myth of the Workforce Crisis. Why the United States Does Not Need More Intensivist Physicians
Abstract
Intensivist physician staffing is associated with lower mortality in the intensive care unit (ICU), yet many ICUs are not staffed by trained intensivists. This gap has led to a number of proposals intended to increase the intensivist supply in the United States. In this perspective we argue that such efforts would be both ineffective and ill-advised. Because many ICU patients are not critically ill, workforce models that base demand projections on ICU admission rather than true critical illness substantially overstate the workforce gap. Even in the presence of a workforce gap, training new intensivists would not place them in hospitals where they are needed most, would not mitigate the shortage of nonphysician critical care providers, and would require a unrealistic increase in spending on physician training. In addition, efforts to train more intensivists require us to prioritize intensive care over other specialties that are also in short supply, without clear justification for why intensivists are more important. Rather than continuing an unwarranted push to increase the intensivist supply, we suggest alternative workforce policies that emphasize novel interprofessional care models (to improve ICU quality in the absence of intensivists) combined with limitations on the future growth of ICU beds (to reduce demand through implicit rationing of care). These policies offer opportunities to reduce the mismatch between critical care supply and demand without an unnecessary expansion of the intensivist supply.
Journal Article