Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-04T18:19:59.478Z Has data issue: false hasContentIssue false
  • English
  • Français

The political economy of rationing health care in England and the US: the ‘accidental logics’ of political settlements

Published online by Cambridge University Press:  23 April 2014

Gwyn Bevan  and
Lawrence D. Brown
Gwyn Bevan*
Affiliation:
Department of Management, London School of Economics, UK
Lawrence D. Brown
Affiliation:
Deparment of Health Policy and Management, Mailman School of Public Health, Columbia University, USA
*
*Corresponding to: Gwyn Bevan, Department of Management, London School of Economics and Political Science, Houghton Street, WC2A 2AE London. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

This article considers how the ‘accidental logics’ of political settlements for the English National Health Service (NHS) and the Medicare and Medicaid programmes in the United States have resulted in different institutional arrangements and different implicit social contracts for rationing, which we define to be the denial of health care that is beneficial but is deemed to be too costly. This article argues that rationing is designed into the English NHS and designed out of US Medicare; and compares rationing for the elderly in the United States and in England for acute care, care at the end of life, and chronic care.

Type
Special Section
Information
Health Economics, Policy and Law , Volume 9 , Issue 3 , July 2014 , pp. 273 - 294
Copyright
© Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aaron, H. J. and Schwartz, W. B. (1984), The Painful Prescription, Washington, DC: Brookings Institution.Google Scholar
Aaron, H. J., Schwartz, W. B. and Cox, M. (2005), Can We Say No? The Challenge of Rationing Health Care, Washington, DC: Brookings Institution.Google Scholar
Anderson, G. F., Reinhardt, U. E., Hussey, P. S. and Petrosyan, V. (2003), ‘It’s the prices, stupid: why the United States is so different from other countries’, Health Affairs, 22(3): 89–105.CrossRefGoogle ScholarPubMed
Anderson, G. F., Hussey, P. S., Frogner, B. K. and Waters, H. R. (2005), ‘Health spending in the United States and the rest of the industrialized world’, Health Affairs, 24: 903–914.CrossRefGoogle ScholarPubMed
Arrow, K. J. (1963), ‘Uncertainty and the welfare economics of medical care’, American Economic Review, 53: 941–973.Google Scholar
Barr, N. and Diamond, P. (2006), ‘The Economics of Pensions’, Oxford Review of Economic Policy, 22(1): 15–39.CrossRefGoogle Scholar
Barer, M. L., Evans, R. G., Hertzman, C. and Lomas, J. (1987), ‘Aging and health care utilization: new evidence on old fallacies’, Social Science and Medicine, 24(10): 851–862.CrossRefGoogle ScholarPubMed
Beech, R., Bevan, G. and Mays, N. (1990), ‘Spatial equity in the NHS: the death and rebirth of RAWP’, in Harrison A. (ed.) Health Care UK 1990, Newbury: Policy Journals, 44–61.Google Scholar
Bernstein, N. (2012), ‘With Medicaid, Long-Term Care of Elderly Looms as Rising Cost’, New York Times, 7 September.Google Scholar
Bevan, A. (1978), In Place of Fear, London: Quartet.Google Scholar
Bevan, G. (2009), ‘The search for a proportionate care law by formula funding in the English NHS’, Financial Accountability and Management, 25(1): 391–410.CrossRefGoogle Scholar
Bevan, G. and Hood, C. (2006), ‘What’s measured is what matters: targets and gaming in the English public health care system’, Public Administration, 84(3): 517–538.CrossRefGoogle Scholar
Bevan, G. and Robinson, R. (2005), ‘The interplay between economic and political logics: path dependency in health care in England’, Journal of Health Politics, Policy and Law, 30(1–2): 53–78.CrossRefGoogle ScholarPubMed
Brown, L. D. (2011), ‘The elements of surprise: how health reform happened’, Journal of Health Politics, Policy and Law, 36(3): 419–427.CrossRefGoogle ScholarPubMed
Brown, L. D. (2012a), ‘The fox and the grapes: is real reform beyond reach in the United States?’ Journal of Health Politics, Policy and Law, 37(4): 587–609.CrossRefGoogle ScholarPubMed
Brown, L. D. (2012b), ‘Stealing On Insensibly’: end-of-life politics in the United States’, Health Economics, Policy and Law, 7(4): 467–483.CrossRefGoogle ScholarPubMed
Cabinet Office (2010), The Coalition: Our Programme for Government. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/78977/coalition_programme_for_government.pdf [9 April 2014].Google Scholar
Centers for Medicare and Medicaid Services (2013), Bariatric Surgery, Centers for Medicare and Medicaid Services: United States. http://www.cms.gov/Medicare/Medicare-General-Information/MedicareApprovedFacilitie/Bariatric-Surgery.html [9 April 2014].Google Scholar
Claxton, K., Martin, S., Soares, M., Rice, N., Spackman, E., Hinde, S., Devlin, N., Smith, P. C. and Sculpher, M. (2013), Methods for the Estimation of the NICE Cost Effectiveness Threshold. Centre for Health Economics, University of York, CHE Research Paper, p. 81. http://www.york.ac.uk/media/che/documents/papers/researchpapers/CHERP81_methods_estimation_NICE_costeffectiveness_threshold_%28Nov2013%29.pdf [30 March 2014].Google Scholar
Connolly, S., Bevan, G. and Mays, N. (2011), Funding and Performance of Healthcare System in the Four Countries of the UK Before and After Devolution, London: Nuffield Trust for Research and Policy Studies in Health Services.Google Scholar
Daniels, N. (1990), Just Health Care, Cambridge: Cambridge University Press.Google Scholar
Daniels, N. (2003), ‘Democratic equality: Rawls’s complex egalitarianism’, in S. Freeman (ed.) The Cambridge Companion to Rawls, Cambridge: Cambridge University Press, 241–276.Google Scholar
Department of Health (2007), 2006–07 and 2007–08 Primary Care Trust initial revenue resource limits. Table 4a.5 and Annex D, United Kingdom. http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Managingyourorganisation/Financeandplanning/Allocations/DH_4104471 [9 April 2014].Google Scholar
Department of Health (2012), The NHS Constitution for England, London, United Kingdom: Department of Health http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_132958.pdf [9 April 2014].Google Scholar
Dworkin, R. (1992), ‘Justice in the distribution of health care’, McGill Law Journal, 38: 883–898.Google Scholar
Dworkin, R. (2000), Sovereign Virtue: The Theory and Practice of Equality, London: Harvard University Press.Google Scholar
Eichner, J. and Vladeck, B. C. (2005), ‘Medicare as a catalyst for reducing health disparities’, Health Affairs, 24(2): 365–375.CrossRefGoogle ScholarPubMed
Evans, R. G. (1987), ‘Public health insurance: the collective purchase of individual care’, Health Policy, 7: 115–134.CrossRefGoogle ScholarPubMed
Faden, R. R. and Chalkidou, K. (2011), ‘Determining the value of drugs – the evolving British experience’, The New England Journal of Medicine, 364: 1289–1291.CrossRefGoogle ScholarPubMed
Food and Drug Administration (FDA) (2011), FDA Expands Use of Banding System for Weight Loss, FDA: United States. http://www.fda.gov/newsevents/newsroom/pressannouncements/2011/ucm245617.htm [9 April 2014].Google Scholar
Fradkin, J. E. (2012), ‘Confronting the urgent challenge of diabetes: an overview’, Health Affairs, 31(1): 12–19.CrossRefGoogle ScholarPubMed
Gawande, A. (2010), ‘Letting go: what should medicine do when it can’t save your life’, New Yorker, 2 August. http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande [30 March 2014].Google Scholar
Gottlieb, D. J., Zhou, W., Song, Y., Andrews, K. G., Skinner, J. S. and Sutherland, J. M. (2010), ‘Prices don’t drive regional Medicare spending variations’, Health Affairs, 29(3): 537–543.CrossRefGoogle ScholarPubMed
Gray, B. H. (2011), England’s Approach to Improving End-of-Life Care: A Strategy for Honoring Patients’ Choices, New York: Commonwealth Fund.Google ScholarPubMed
House of Commons, Public Accounts Committee (2009), End of Life Care. Nineteenth Report of Session 2008–09, London: Stationary Office.Google Scholar
Jost, T. S. (2014), ‘Implementing health reform: four years later’, Health Affairs, 33(1): 7–10.Google Scholar
Judge, A., Welton, N. J., Sandhu, J. and Ben-Shlomo, Y. (2010), ‘Equity in access to total joint replacement of the hip and knee in England: cross sectional study’, BMJ, 341: c4092.CrossRefGoogle ScholarPubMed
Kaiser Family Foundation (2011), Medicare Spending and Financing, Washington, DC: The Henry J. Kaiser Family Foundation.Google Scholar
King’s Fund (2000), Age Discrimination in Health and Social Care, London: King’s Fund http://www.kingsfund.org.uk/publications/age-discrimination-health-and-social-care [30 March 2014].Google Scholar
Klein, R. (2010), The New Politics of the NHS: From Creation to Reinvention, 6th edition, London: Radcliffe.Google Scholar
Klein, R. and Maybin, J. (2012), Thinking About Rationing, London: King’s Fund.Google Scholar
Marmor, T. (2000), The Politics of Medicare, second edition, New York: Aldine de Gruyter.Google ScholarPubMed
Marmor, T. (2012), ‘American health care policy and politics’, in T. R. Marmor and R. Klein (eds), Politics Health and Health Care, London: Yale University Press, 37–52.Google Scholar
Marmor, T. and McKissick, G. J. (2012), ‘Medicare’s future’, in T. R. Marmor and R. Klein (eds), Politics Health and Health Care, London: Yale University Press, 53–88.Google Scholar
Morgan, S. and Kennedy, J. (2010), Prescription Drug Accessibility and Affordability in the United States and Abroad, New York: The Commonwealth Fund.Google ScholarPubMed
National Health Service (NHS) (2010), The NHS Atlas of Variation in Healthcare, United Kingdom: NHS. http://www.rightcare.nhs.uk/index.php/atlas/atlas-of-variation-2011/ [9 April 2014].Google Scholar
National Institute for Health and Clinical Excellence (NICE) (2011), NICE Draft Guidance Extends Recommendations on Alzheimer’s Drugs, London, United Kingdom: National Institute for Health and Clinical Excellence http://www.nice.org.uk/newsroom/pressreleases/NICEDRAFTGuidanceOnAlzheimersDrugs.jsp [9 April 2014].Google Scholar
National Institute for Health and Clinical Excellence (NICE) (2014), Technology Appraisal Recommendation Summary, United Kingdom: NICE. http://www.nice.org.uk/newsroom/nicestatistics/TADecisionsRecommendationSummary.jsp [9 April 2014].Google Scholar
NHS Choices (2014), Your health, your way. http://www.nhs.uk/planners/yourhealth/pages/prescriptioncosts.aspx [30 March 2014].Google Scholar
Neumann, P. J. and Weinstein, M. C. (2010), ‘Legislating against use of cost-effectiveness information’, New England Journal of Medicine, 363: 1495–1497.CrossRefGoogle ScholarPubMed
Newhouse, J. P. (1993), ‘An iconoclastic view of health cost containment’, Health Affairs, 12(Supplement): 152–171.CrossRefGoogle ScholarPubMed
OECD (2011), Health at a Glance 2011. http://www.oecd.org/els/health-systems/49105858.pdf [30 March 2012].Google Scholar
OECD (2013a), Health at a Glance 2013. http://www.oecd.org/els/health-systems/Health-at-a-Glance-2013.pdf [30 March 2012].Google Scholar
OECD (2013b), OECD Health Data 2013. http://stats.oecd.org/Index.aspx?DataSetCode=SHA [30 March 2012].Google Scholar
OECD (2013c), Life Expectancy in the US Rising Slower than Elsewhere, Says OECD. http://www.oecd.org/unitedstates/Health-at-a-Glance-2013-Press-Release-USA.pdf [30 March 2014].Google Scholar
Office for National Statistics (2011), General Lifestyle Survey, 2009, United Kingdom: Office for National Statistics.http://www.ons.gov.uk/ons/publications/re-reference-tables.html?edition=tcm%3A77-198839 [9 April 2014].Google Scholar
Owen-Smith, A., Kipping, R., Donovan, J., Hine, C., Maslen, C. and Coast, J. (2013), ‘A NICE example? Variation in provision of bariatric surgery in England’, BMJ, 346: f2453.CrossRefGoogle ScholarPubMed
Reinhardt, U. E., Hussey, P. S. and Anderson, G. F. (2004), ‘U.S. health care spending in an international context’, Health Affairs, 23: 310–325.CrossRefGoogle Scholar
Royal College of Surgeons (2010), Royal College of Surgeons, Conference hears of ‘unfair and unethical’ access to NHS weight loss surgery’, 21 January 2010, www.rcseng.ac.uk/news/conference-hears-of-unfair-and-unethical-access-to-nhs-weight-loss-surgery [9 April 2014].Google Scholar
Royal College of Surgeons (2012), Access All Ages: Assessing the Impact of Age on Access to Surgical Treatment, London: Royal College of Surgeons. http://www.rcseng.ac.uk/publications/docs/access-all-ages [30 March 2014].Google Scholar
Rutenberg., J. and Calmes, J. (2009), ‘False “Death Panel” rumor has some familiar roots’, The New York Times, 13 August. http://www.nytimes.com/2009/08/14/health/policy/14panel.html?_r=1 [9 April 2014].Google Scholar
Secretary of State for Health (2010), Equity and Excellence: Liberating the NHS. Cm7881, London: Department of Health.Google Scholar
Skinner, J. (2011), ‘Understanding prices and quantities in the US health care system’, Journal of Health Politics, Policy and Law, 36(4): 791–801.CrossRefGoogle Scholar
Smith, S., Newhouse, J. P. and Freeland, M. S. (2009), ‘Income, insurance, and technology: why does health spending outpace economic growth?’ Health Affairs, 28: 1276–1284.CrossRefGoogle ScholarPubMed
Sochalski, J., Jaarsma, T., Krumholz, H. M., Laramee, A., McMurray, J. J., Naylor, M. D., Rich, M. W., Riegel, B. and Stewart, S. (2009), ‘What works in chronic care management: the case of heart failure’, Health Affairs, 28: 179–189.CrossRefGoogle ScholarPubMed
Steinbrook, R. (2008), ‘Saying no isn’t NICE – the travails of Britain’s National Institute for Health and Clinical Excellence’, New England Journal of Medicine, 359: 1977–1981.CrossRefGoogle ScholarPubMed
Thorlby, R. and Maybin, J. (2010), A High-Performing NHS? A Review of Progress 1997–2010, London: The King’s Fund.Google Scholar
Timmins, N. (2012), Never Again? The story of the Health and Social Care Act 2012, London: King’s Fund and Institute for Government.Google Scholar
Tuohy, C. (1999), Accidental Logics. The Dynamics of Change in the Health Care Arena in the United States, Britain and Canada, New York: Oxford University Press.CrossRefGoogle Scholar
UK House of Commons, Committee of Public Accounts (2013), Department of Health: Progress in Making NHS Efficiency Savings. Thirty-Ninth Report of Session 2012–13. HC 865, London: The Stationery Office Limited. http://www.publications.parliament.uk/pa/cm201213/cmselect/cmpubacc/865/865.pdf [30 March 2014].Google Scholar
Webster, C. (1988), The Health Services Since the War. Volume I. Problems of the National Health Service Before 1957, London: HMSO.Google Scholar
Webster, C. (ed.) (1991), Aneurin Bevan on the National Health Service, Oxford: University of Oxford.Google Scholar
Williams, A. (1985), ‘The economics of coronary artery bypass grafting’, BMJ, 291: 326–329.CrossRefGoogle ScholarPubMed
Williams, A. (1997), ‘Equity: intergenerational equity: an exploration of the ‘fair innings’ argument’, Health Economics, 6(2): 117–132.3.0.CO;2-B>CrossRefGoogle ScholarPubMed
Wolff, J. L., Starfield, B. and Anderson, G. (2002), ‘Prevalence, expenditures, and complications of multiple chronic conditions in the elderly’, Archives of Internal Medicine, 162: 2269–2276.CrossRefGoogle ScholarPubMed
Zweifel, P., Felder, S. and Meiers, M. (1999), ‘Ageing of population and health care expenditure: a red herring?’, Health Economics, 8(6): 485–496.3.0.CO;2-4>CrossRefGoogle ScholarPubMed