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Bedside Rationing by Health Practitioners: A Case Study in a Ugandan Hospital

Author

Listed:
  • Lydia Kapiriri

    (Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada)

  • Douglas K. Martin

    (Joint Centre for Bioethics, Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada, lydia.kapiriri@utoronto.ca)

Abstract

Purpose. The purpose of this study was to describe bedside rationing by health practitioners in a teaching hospital in Uganda. Methods. This was a case study involving in-depth interviews. A modified thematic approach was used in data analysis. Types of decisions, the decision-making process, key players, and hospital-, medical-, and patient-related considerations in the process were identified. Klein’s 6 forms of rationing were used to identify the forms of rationing used. The setting was a tertiary hospital in Uganda. Theoretical sampling was used to identify 40 doctors and 16 nurses from the Departments of Medicine, Surgery, Paediatrics, and Obstetric and Gynaecology. Results. Four types of bedside rationing decisions were identified: 1) which patients are seen first, 2) which treatment the patients receive, 3) which patients are admitted, and 4) which patients are taken to the operating theatre first. Hospital-related considerations regarding bedside rationing included the hospital budget and number of beds; medical-related considerations included the patient’s diagnosis and effectiveness of treatment; and patient-related considerations included poverty, social status, and age. All forms of rationing (denial, dilution, deflection, deterrence, delay, and termination) were practiced. Conclusion. Although bedside rationing decisions in the study hospital seem somewhat similar to that in developed countries, the rationing of 1st-line drugs by health practitioners in Uganda is complex, difficult, and different from what has been described in industrialized countries. The complexity and severity of the consequences of the bedside decisions necessitate the development of resource-sensitive clinical guidelines and transparent decision-making processes to foster patients’ understanding of the reasons and the procedures and to ensure fair decision-making processes.

Suggested Citation

  • Lydia Kapiriri & Douglas K. Martin, 2007. "Bedside Rationing by Health Practitioners: A Case Study in a Ugandan Hospital," Medical Decision Making, , vol. 27(1), pages 44-52, January.
    • Handle: RePEc:sae:medema:v:27:y:2007:i:1:p:44-52
    DOI: 10.1177/0272989X06297397
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    References listed on IDEAS

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    1. Jitta, Jessica & Whyte, Susan Reynolds & Nshakira, Nathan, 2003. "The availability of drugs: what does it mean in Ugandan primary care," Health Policy, Elsevier, vol. 65(2), pages 167-179, August.
    2. Daniels, Norman & Sabin, James E., 2002. "Setting Limits Fairly: Can we learn to share medical resources?," OUP Catalogue, Oxford University Press, number 9780195149364.
    3. Arnesen, Kjell E. & Erikssen, Jan & Stavem, Knut, 2002. "Gender and socioeconomic status as determinants of waiting time for inpatient surgery in a system with implicit queue management," Health Policy, Elsevier, vol. 62(3), pages 329-341, December.
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    1. Williams, Iestyn & Allen, Kerry & Plahe, Gunveer, 2019. "Reports of rationing from the neglected realm of capital investment: Responses to resource constraint in the English National Health Service," Social Science & Medicine, Elsevier, vol. 225(C), pages 1-8.
    2. Ingrid Miljeteig & Frehiwot Berhane Defaye & Paul Wakim & Dawit Neema Desalegn & Yemane Berhane & Ole Frithjof Norheim & Marion Danis, 2019. "Financial risk protection at the bedside: How Ethiopian physicians try to minimize out-of-pocket health expenditures," PLOS ONE, Public Library of Science, vol. 14(2), pages 1-16, February.
    3. Owen-Smith, Amanda & Donovan, Jenny & Coast, Joanna, 2015. "How clinical rationing works in practice: A case study of morbid obesity surgery," Social Science & Medicine, Elsevier, vol. 147(C), pages 288-295.

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