Who lives? Who decides?
Some experts say to control medical costs, America must ration health care. Others argue that care is already rationed in the U.S., often in hidden ways.It’s a highly charged issue. Even the term "rationing" is subject to dispute.PRI's The World takes a global look at the topic with four perspectives from four countries.
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India: Rationing in Disasters
Medical rationing sometimes seems inevitable during disasters.Major earthquakes, floods, and pandemics can leave health workers scrambling to care for all the patients who need attention—and can force some patients to go without.But even in such dire circumstances, can rationing be avoided?An Indian doctor offers a hopeful tale.
The emergence of H1N1 or “swine” flu last year raised fears around the world of a severe pandemic.
In the United States, health officials planned for the worst. They were concerned that the number of patients needing artificial breathing support might far exceed the number of hospital ventilators available.
Zambia: Rationing by Queue
The rationing of health care is not always obvious or explicit.Implicit factors may determine who receives care and who does not.One such factor may have imposed a form of unintentional rationing on AIDS care in Africa.
The Southern African nation of Zambia, with one of the highest HIV infection rates in the world, has come a long way in its fight against AIDS.
A decade ago, government clinics provided no drugs to treat the virus. Physicians “just looked at patients and watched them die,” recalled Dr. Peter Mwaba.
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United Kingdom: Rationing by Cost
Some argue that the goal of medical rationing should be to focus resources where they will offer the greatest health benefit to the greatest number of people.That is the aim of the UK’s rationing plan.But Britain’s plan is now under fire.
If ever there were a place where the public might embrace the rationing of health care, that place would arguably be Britain.
During World War II and for nine years after, the British government rationed most food items: meat, flour, eggs, sugar. The government also strictly controlled the supply of gasoline, soap, stockings—even the number of buttons on jackets.
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South Africa: Rationing by Committee
In South Africa, the government puts limits on life-sustaining kidney dialysis,and that puts medical professionals in a difficult position.They are tasked with deciding who lives and who dies.This is the story of two patients—and the committee that determined their fates.
In late August, Amos Phillips, 41, arrived by ambulance at Tygerberg Academic Hospital near Cape Town. His kidneys had failed. He was confused, struggling to breathe, and desperate enough to ask doctors to end his life.
Karen MacPherson, 43, was also treated at Tygerberg that month, and she desperately wanted to live. A widow with three children, she said she had been plagued by high blood pressure, a risk factor for kidney disease, since her children’s birth.