Twenty percent of Americans do not have health insurance which makes access to healthcare services impossible (Weale 1998). Ideally high quality healthcare should be available to the entire population and the allocation should be based on medical need instead of finances (Weale 1998).
The increased costs of healthcare have threatened this ideal measure of malfeasance because of the inconsistent triad (Weale 1998). This triad of principles is high quality care for some, low quality comprehensive care to all, or high quality care that is not comprehensive for all (Weale 1998).
Determining which of these scenarios is the best form of resource allocation has been a controversial topic for healthcare industry leaders (Weale 1998).
Healthcare rationing is defined as withholding potentially beneficial services through the design of the delivery system (Norheim 1999). Clinical practice guidelines can be perceived as a method of implementing evidence based principles into clinical practice (Norheim 1999).
The purpose of clinical practice guidelines is to manage the behavior of practitioners to influence the decision making process (Norheim 1999). Clinical practice guidelines help practitioners allocate healthcare resources to maximize the value received from these services (Norheim 1999).
The most important measure of a clinical guideline’s impact on healthcare rationing is the reduction of local variations in practice (Norheim 1999). To achieve this goal the developers of these clinical guidelines must demonstrate transparency which will foster the respect of patients (Norheim 1999).
Disadvantaged people receive restricted access to healthcare service and the goal of healthcare rationing is to reduce the variability in access (Light 1997). The current system promotes healthcare insurance carriers to selectively choose the participant in the plan which leaves a large segment of the population without adequate access (Light 1997).
This two tier system causes a substantial difference in access to healthcare services among the insured and uninsured (Light 1997). This two tier system of healthcare service delivery allows for the minimization of services for the uninsured and the maximization of services for the insured leading to higher healthcare premiums (Light 1997).
Healthcare service rationing based on medical need seeks to eliminate the waste of valuable resources maximizing the efficiency of allocation (Light 1997).
Technology has had the greatest impact on healthcare service delivery which enables the independent living of those living with a disability (Hansson 2007). There are four types of technology in healthcare therapeutic, compensatory, assistive, and universal (Hansson 2007).
Therapeutic technology restores biological function that has been lost which includes implants and other treatments (Hansson 2007). Compensatory replaces a lost biological function with a new one of general nature to reduce the disability by providing new abilities (Hansson 2007).
Assistive technology makes it possible increases the possibility of completing a takes despite the presence of a disability (Hansson 2007). Universal technology is for use by people without a specific disease or disability and this can be adjusted to the user (Hansson 2007).
This is used more for social purposes than health needs and is an unintended consequence of the drive to maximize independence for the disabled (Hansson 2007).
The impact of healthcare rationing must ensure the resources are allocated in an ethical manner based on needs. Clinical practice guidelines based on research should guide the development of these principles.
The guidelines should guide the allotment of the technologic advances now available. Once these principle are implemented we should have increased justice and efficient cost control measures to guide healthcare providers.
Hansson, S. O. (2007). The Ethics of Enabling Technology. Cambridge Quarterly of
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Norheim, O. F. (1999). Healthcare Rationing: Are Additional Criteria needed for
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Weale, A. (1998). Rationing Healthcare. British Medical Journal. 316 (7129) 410.
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