Ethics, Justice, and Medical Care Systems

As medical costs mount and as government as sumes increasing responsibility for financing, explicit forms of medical care rationing are likely to be introduced. This paper considers the benefits and costs of different approaches to rationing and their implications for a just medical care system. Rationing may be imposed through financial barriers for the patient in the form of coinsurance and deductibles or in limitations on the funds, facilities, and services made available to the population. It is argued that imposing barriers to access on the theory that consumers are in a good position to make necessary differentiations places the burden of ra tioning on the patient who is least able to make the decision rationally, and places the poor, who have the least medical knowledge and background, in particular jeopardy. Other al ternatives include either the introduction of fixed budgets that require professionals to establish priorities or adminis trative decisions that prescribe the facilities and types of serv ices made available to varying population groups. Rationing techniques have different behavioral and ethical implications, and existing research indicates that the consequences of some rationing approaches are inconsistent with theoretical as sumptions.