Biomaterial Database

The problems with rule-based rationing. 1994

M A Hall

Wake Forest University School of Law, Bowman Gray School of Medicine, Winston-Salem, NC 27109.

Centralized, democratic rules are often asserted as a superior basis for rationing than individualized physician discretion. This article counters this prevailing wisdom by exploring the deficiencies of rule-based rationing. Rules are too imprecise to accurately reflect all the nuances of physical and mental impairment and the complexity of medical science, particularly considering the widely varying personal values that different patients attach to medical risk and benefit. Rule-based rationing also suffers from the biasing effects of interest group pressure on political processes and the tendency to absolve physicians from any moral responsibility for the rationing decisions they implement. Internalizing cost constraints is a more socially and professionally acceptable means of rationing and, in any event, it is inevitable since even a preponderance of rule-based rationing will leave considerable areas of discretion for physician judgment in the implementation and interpretation of the rules. As a consequence, despite the flaws of bedside rationing, it is foolhardy to dispense with it entirely in favor of an exclusively rule-based system.

UI	MeSH Term	Description	Entries
D008119	Lobbying	A process whereby representatives of a particular interest group attempt to influence governmental decision makers to accept the policy desires of the lobbying organization.	Lobbyings
D008722	Methods	A series of steps taken in order to conduct research.	Techniques,Methodological Studies,Methodological Study,Procedures,Studies, Methodological,Study, Methodological,Method,Procedure,Technique
D009922	Oregon	State bounded on the north by Washington, on the east by Idaho, on the south by California and Nevada, and on the west by the Pacific Ocean.
D010816	Physician Incentive Plans	Compensatory plans designed to motivate physicians in relation to patient referral, physician recruitment, and efficient use of the health facility.	Incentive Plans, Physician,Incentive Plan, Physician,Physician Incentive Plan,Plan, Physician Incentive,Plans, Physician Incentive
D010819	Physician's Role	The expected function of a member of the medical profession.	Physicians' Role,Physician Role,Physician's Roles,Physicians Role,Physicians' Roles,Role, Physician's,Role, Physicians',Roles, Physician's,Roles, Physicians'
D011057	Politics	Activities concerned with governmental policies, functions, etc.	Political Activity,Conservatism,Decentralization,Liberalism,Political Factors,Activities, Political,Activity, Political,Factor, Political,Factors, Political,Political Activities,Political Factor
D003657	Decision Making	The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea.	Credit Assignment,Assignment, Credit,Assignments, Credit,Credit Assignments
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012945	Social Values	Abstract standards or empirical variables in social life which are believed to be important and/or desirable.	Value Orientation,Values, Social,Value Orientations
D013221	State Health Plans	State plans prepared by the State Health Planning and Development Agencies which are made up from plans submitted by the Health Systems Agencies and subject to review and revision by the Statewide Health Coordinating Council.	Comprehensive Health Plans, State,Health Plan, State,Health Plans, State,Plan, State Health,Plans, State Health,State Health Plan