10 Ways Doctors Ration Healthcare

Healthcare rationing is an inevitable consequence of having too few resources to satisfy an almost endless and escalating demand for services. The challenge is not to deny rationing, but to manage or mitigate it using an approach that optimizes inputs.

A lot of people think that sick-care can learn a lot from Disney. In fact, when a large academic campus decided to relocate, they hired Disney to help design the facility. But, you can only take it so far. You get valet parking, but Goofy won't be parking your Mercedes.

When it comes to myths about Sickcare, USA, I think many of us already live in Fantasyland. One myth is that we all get the same care. There are 3 things you should never talk about at the dinner table-politics, religion, and healthcare rationing.

The topic generates more heat than light. Definitions are ill-defined and the role of doctors is confusing.

Economists usually consider all limits on the distribution of a scarce good or services to be "rationing," whether that limit takes the form of a price barrier or some method of non-price allocation—for example, queues or allocation by lottery. To make a distinction between allocation through freely competitive markets and other forms of resource allocation, economists distinguish between "price rationing" and "non-price rationing.”

Then there is the issue of the responsibility of doctors to provide care to all regardless of the scarcity of the resource or ability to pay. The traditional notion is that the patient should be the primary interest. But, the reality is that nothing gets spent unless the doctors says it should and they are being held more and more accountable for wasting resources, prescribing high-priced drugs that might be effective or not, or doing procedures or using technologies that don't add value. Throw in their responsibility to their employers to make the numbers and cut costs, and soon things get very dicey.

There are many overt and covert ways doctors "ration" care:

1. They refuse to see patients who can't pay.

2. They ration by inconvenience, making it so hard to access their services that you give up trying.

3. They do things, knowingly or not, to a certain subset of their patients, based on gender, race, ethnicity or level of obesity that they would not do for others, contributing to health disparities.

4. They don't learn how to use new technologies that are more cost-effective.

5. They knowingly or unknowingly prescribe drugs that the patient can't afford.

6. Surgeons schedule surgery only on days that are convenient to them (mostly on Tuesday) but inconvenient for the patient. The result are no-shows.

7. They open practices in favorable geographic areas rather than underserved or rural areas.

8. They go into specialties that generate the most revenue rather than serving a community with the most need for generalists.

9. They use inefficient practice management systems that discourage consulting them.

10. They self-deal or have conflicts of interest that create a motivation to ration a particular resource or they are part of a system that pays them for "value" that is often a smokescreen for cutting spending.

Sick-care rationing is an inevitable consequence of having too few resources to satisfy an almost endless and escalating demand for services. Technology, the aging population, and the dropping birth rates will only make it worse. The challenge is not to deny rationing, but to manage or mitigate it using an approach that optimizes inputs.

Call me Goofy, but it will take more than Snow White waving her magic wand to make it happen.