Rationing of expensive medical care in a transition country—nihil novum?

Abstract

This article focuses on rationing of expensive medical care in the Czech Republic. It distinguishes between political and clinical decision levels and reviews the debate in the Western literature on explicit and implicit rules. The contemporary situation of the Czech health care system is considered from this perspective. Rationing reoccurred in the mid 90s after the shift in health care financing from fee-for-service to prospective budgets. The lack of explicit rules is obvious. Implicit forms of rationing, done by physicians at the clinical level prevail, implying uncontrolled power of the medical profession and lacking transparency for ethical considerations of equity to access. It seems to be acceptable for physicians to play the role of allocators, probably because of their experience with rationing during the socialist period. Traditional rationing stereotypes from the previous regime seem to persist despite the health care system transformation during the 90s.

The impetus for the development of Hospital in the Home (HITH) programs: A literature review

“…It is not difficult to see why the disruptions to home life are disregarded in the move towards increased use of HITH programs. Increasing effiCiency is linked to outcomes, accountability, throughput, and identifying blocks in the public hospital system because health care has become a resource to be managed (Krizova & Simek, 2002;Rees & RodIey, 1995). According to Giddens (1991), capitalistic concerns represent the fundamental driving force behind modern institutions and aim to shape individual consumption.…”

Short-term physical and emotional health outcomes of public sector ART in the Free State province of South Africa

“…When patients qualifying for ART on clinical grounds exceed the supply of services, a set of criteria for achieving equitable ART provisioning within sites is required [49][50][51]. By including equity measures, the study model can take into account the influence of patient characteristics on health outcomes.…”

Medical Ethics in the Czech Republic - Experiences in the Post-Totalitarian Country"

“…We put together information, which we just published in relevant journals. (Krizova & Simek, 2002;Krizova & Simek, 2007;Simek at el. 2009;Simek et al 2010) In the research we have addressed three issues that we use as case examples of how medical ethics in the Czech Republic has manifested in the debate, and how it was implemented in everyday practice.…”

“…In hospitals, fixed budgets have been re-established according to the sum and structure of health care services provided in the previous period (called"historic limits from 1996-1997"). (Krizova & Simek, 2002) While the first transformation period was accompanied with the boom of Western hi-tech medical care, the shift to prospective payments with upper limits has frozen the escalation of volume of care, and even led to a decrease in provided services in some hospitals. According to data provided by The General Health Insurance Company (GHIC), the volume of hospital services fell immediately to 80% on average while the minimum rate being set by the payer (GHIC) was 75% of the entire volume.…”