Health care rationing

Health care rationing refers to mechanisms that are used to allocate health care resources.

Overall health care
Healthcare rationing in the United States is largely accomplished through market forces, though major government programs include Medicare, Medicaid, Veterans Affairs, and the Indian Health Service. Most Americans have private health insurance, and non-emergency health care rationing decisions are made based on what the insurance company or government insurance will pay for, what the patient is willing to pay for (though health care prices are often not transparent), and the ability and willingness of the provider to perform uncompensated care. The Emergency Medical Treatment and Active Labor Act of 1986 requires any properly equipped hospital receiving Medicare funds (nearly all private hospitals) to provide emergency healthcare regardless of citizenship, immigration status, or ability to pay. The government also regulates insurance policies, requiring coverage for some items and controlling the rules for who is eligible and what they can be charged. The 2010 Patient Protection and Affordable Care Act (known as Obamacare) contained many changes to these regulations, including the first requirement that all Americans purchase health insurance (taking effect in 2014), which will significantly change the calculus of rationing decisions, including for preventive care.

In the United Kingdom, the National Institute for Health and Care Excellence sets coverage requirements for the National Health Service, which is funded and operated by the government. NICE calculates an incremental cost-effectiveness ratio in terms of quality-adjusted life years. Treatments under £20,000 per QALY gained are considered cost-effective, but those above £30,000 per QALY are rarely approved. Individuals who are able to do so may also pay for private treatments beyond what the NHS offers, but low-income people largely have equal access to health care. The overall level of government funding for NHS is a political issue in the UK.

Shortages
Shortages of donated organs for transplantation has resulted in the rationing of hearts, livers, lungs and kidneys in the United States, mediated by the United Network for Organ Sharing. During the 1940s, a limited supply of iron lungs for polio victims forced physicians to ration these machines. Dialysis machines for patients in kidney failure were rationed between 1962 and 1967. More recently, Tia Powell led a New York State Workgroup that set up guidelines for rationing ventilators during a flu pandemic. Among those who have argued in favor of health-care rationing are moral philosopher Peter Singer and Oregon governor John Kitzhaber.