What is rationing in healthcare? As a definition, healthcare rationing is limiting health care services only to those individuals who can afford to pay for them. Nowadays, this concept is becoming more and more common. Cost and affordability are the two factors upon which access to private health insurance is rationed. At times, insurance companies may even pre-screen applicants for pre-existing medical conditions or refuse to cover an applicant’s additional medically related expenses. According to federal and state regulations, access to Medicaid programs is limited by income and assets. Furthermore, healthcare maintenance organizations that typically cover a major portion of the population, limit access to treatment by means of clinical and financial restrictions. Several advocates have stated that rationing health care is an effective approach towards ensuring cost-effective U.S. Medicare and Medicaid programs.

In the United States, healthcare rationing exists in several different forms:

• Rationing by insurance companies;
• Rationing by pharmaceutical companies;
• Rationing by high prices;
• Rationing through government control;
• Rationing by limited choice and access;

“Health care is a scarce resource, and all scarce resources are rationed in one way or another. In the United States, most health care is privately financed, and so most rationing is by price: you get what you, or your employer, can afford to insure you for. But our current system of employer-financed health insurance exists only because the federal government encouraged it by making the premiums tax deductible. That is, in effect, a more than $200 billion government subsidy for health care. In the public sector, primarily Medicare, Medicaid and hospital emergency rooms, health care is rationed by long waits, high patient copayment requirements, low payments to doctors that discourage some from serving public patients and limits on payments to hospitals” wrote Peter Singer for the New York Times Magazine in 2009.

U.S healthcare is rationed according to salary, type of employment, as well as pre-existing medical conditions. A study conducted in 2008 at the Urban Institute found that 43% of healthcare spending was for uninsured non-elderly Americans, similar to Americans that were privately insured. The data implied rationing by price and ability to pay. In the United States in 2010, it was estimated that over 50 million individuals had no health insurance. Either they could not afford the cost of private coverage or they had restrictions in getting health insurance.

As to whether rationing is the future of healthcare, it has been stated that it may be a reasonable approach towards more affordable priced health insurance policies. However, as a healthcare professional, if you cannot collect fees for services rendered from the uninsured, you may choose to raise the prices for your services in order to cover your losses. This, in turn, will mean higher medical costs and high insurance premiums – all leading to the need for more funding. The dawn of rationing is likely to bring about a combination of developments such as detailed information on the different types of illnesses, the number of patients who suffer from them, as well as the effectiveness of treatment methods. Such developments will raise issues regarding how many patients are likely to develop specific diseases and how to track the effectiveness of treatment methods. In turn, this will bring about changes in the physician’s role.

The necessity of rationing in the healthcare industry does not necessarily mean that all rationing is justifiable, or rather a justifiable decision. One such instance is rationing decisions in the ICU. Patients in the ICU require ongoing monitoring so you need to routinely ration your time in order to accommodate to their medical needs. You must decide which patients to see first and how much time you should spend with each one. Therefore, you need balance your personal life and professional life, all the while providing quality care to those in need. The reality of practices in the ICU is that some patients are denied a few benefits – however small – due to such necessary rationing decisions.

So why such rationing decisions encouraged and what are bringing about the growth of healthcare costs? For one thing, the advancement of new technologies and medications is leading to their inappropriate use. Secondly, unnecessary, expensive tests are often ordered for diagnosis when all it takes is looking into the patient’s medical history. Thus, increasing costs means limiting access to medical advancements and the availability of costly medical tests only to specific groups and whenever necessary. Last but not least, patient lifestyle is a major factor for the growth of healthcare costs. Lifestyle decisions, in one way or another, tend to lead to results of complex medical conditions – diabetes, stroke, etc. Such conditions can be rather difficult to manage and expensive to treat. In fact, over 70% of health claims are paid due to such instances and until patient lifestyles are adjusted, costs will continue to rise. These are some of the most noteworthy reasons for growing costs but perhaps with greater attention to lifestyle changes and an emphasis on patient-physician relationships, a significant amount of money can be saved, all the while encouraging high-quality care.

Most U.S healthcare is privately financed, meaning that it is rationed by price. Rationing health care means getting value for patients’ visits as well as receiving payment for the services that you provide. It means knowing where finances are going and setting limits to unnecessary treatments paid for by the public’s budget. When U.S. public funds are advocating for health care, it is not necessarily irrational to strive to get your money’s worth. Yet, the debate over the future of health care in the United States should begin by asking one simple question: what is the ideal way to do it?

Above all, all health care systems ration care; however, there are good ways and bad ways to do it. Rationing poorly is allowing access to quality health care only to those who can afford it and excluding it from those who suffer from far more complex medical conditions due to lack of access and affordability. As the cost of health care continues to rise above the nation’s ability to pay, the pressure to keep medical costs down is unavoidable. However, current solutions have yet to find a rational and effective approach that is in the best interest to the medical need of all Americans. Rationing by ability to pay is fairly simple to implement but it fails to address other unpredictable factors among the healthcare industry such as medical error, rising costs for new medications, as well as operational inefficiencies. Healthcare reform by increasing collaboration among patients and physicians, such as you, is a clear and simple way to increase value. This approach will allow you to reduce medical error, leverage modern technological tools, as well as put your efforts in physician leadership. The ending result will be higher performance at lower cost.

Rationing in healthcare is necessary and it is unavoidable. Some physicians struggle with the idea of rationing, denying that their professional obligations require them not to participate in rationing. They feel they would be compelled to make decisions based on maximal value for the society and less toward the best interests of individual patients. Others, however, support rationing and view the allocation of medical care as a mere part of their ethical duties. They argue that cost-effective rationing, above all, strives to deliver and achieve greater health benefits to all. The fact of the matter is that to date, there is no ideal solution. In any case, the levels at which healthcare is rationed are all important structures that should be taken into consideration upon building and delivering a quality healthcare system. How rationing is delivered is vital not just in its impact on individuals lives but also in the value that is presented among society. With more and more resources becoming available and information on medical care, transforming the U.S. health care will take time and it will have its challenges; however, it is an approach that can provide great benefits to all Americans.