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healthcare rationing

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Updated October 08, 2008

Definition:

Most patients believe, unless they decide to pay for it from their own pocket, that if a treatment exists for a medical problem, then that treatment should be provided and paid for by insurance (or whoever takes care of their healthcare), regardless of the cost.

Payers, and some doctors, however, will weigh the cost of a treatment against the expected outcomes to determine whether the treatment should be made available to a patient. This is called "rationing."

For example:

Rationing takes place when a treatment is denied by a health insurance company. Those rationing decisions are often made by weighing the cost of the treatment against the potential improvement in the patient/insured's health.

  • A patient who needs a very expensive drug, which may only prolong life for a few months, will likely be denied that drug by the insurance company, although the patient can still choose to pay for it himself.

  • A patient who wants plastic surgery to improve the shape of her nose will be denied coverage, because even though it may improve her appearance, it won't improve her health.

Self-rationing takes place when a patient chooses an over-the-counter remedy for symptoms instead of going to the doctor, where he will have to copay for the visit and whatever drug is prescribed.

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