Health Care Priorities and the Effects of Double Rationing

Abstract

The purpose of my research is to investigate "double rationing" which entails rationing at two levels of the health care system. At one level, policy makers prioritize treatments that will be covered under a publicly financed health care system. At a lower level, doctors or other health care professionals prioritize patients in need of scarce medical treatments. Traditionally, research focusing on health care rationing has treated these two activities as if they were separate and unrelated events. This research considers the effects of lower level prioritization activities on the ability of policy-makers to achieve their own (and arguably, societal) health policy objectives.

An experiment that included two prioritization tasks – one where subjects prioritized patients and another where they prioritized treatments -examined how subjects made prioritization decisions for each activity and showed that the usage of values varied across tasks. Furthermore, within tasks, groups of subjects with different prioritization policies emerged. These "clusters" of subjects were used to model the effects of using different prioritization policies at different levels of the health care system. The results of the modeling exercise suggest that patient prioritization decisions can affect the achievement of high-level heath policy goals – but that under the conditions used in the model – lower level decisions are not likely to have a large impact on achievement of health policy goals. Conditions under which lower level prioritization decisions are expected have a more substantial impact on the achievement of health policy goals and options for coordinating multi-level prioritization decisions are discussed.