Rationing health care: Views from general practice☆
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Cited by (34)
How clinical rationing works in practice: A case study of morbid obesity surgery
2015, Social Science and MedicineCitation Excerpt :Despite the importance of decision-making at the macro and meso level, it has been argued that the most critical resource allocation decisions are made at the consultation or ‘bedside’ level as part of routine clinical interactions between doctors and patients (Aaron and Schwartz, 1984; Maybin and Klein, 2012; Ubel and Goold, 1997). This is also generally accepted to be the most implicit level of decision-making, and empirical work at this level suggests that, despite a commitment to rationing openly in theory, clinicians are so conflicted by their responsibility to ration that they retreat to more implicit methods in practice (Ayres, 1996; Carlsen and Norheim, 2005; Jones et al., 2004; Owen-Smith et al., 2009). Implicit rationing techniques include rationing by delaying patients from accessing care, by deterring them from accessing particular treatments, by deflecting them to other services, and by diluting the quality of care available (Maybin and Klein, 2012; Box 1).
Is patient involvement possible when decisions involve scarce resources? a qualitative study of decision-making in primary care
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Disclaimer: the comments and conclusions drawn from this work are those of the author, and not necessarily those of Wakefield Healthcare.
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Current address: Division of Public Health, Nuffield Institute for Health, 71–75 Clarendon Road, Leeds LS2 9PL, England.