doi.org/10.52340/eab.2024.16.03.08

Health rationing has been the subject of debate in health economics in recent years. It is a concept that deals with the allocation of limited healthcare resources. Due to the increase in the demand for health services, the costs increase significantly, which leads to the need for rationing of health care to provide medical services to patients. However, the public discourse on this issue mainly focuses on ethical considerations, with less emphasis on economic rationality. The economic rationality of health rationing is essential to healthcare decision-making.
Health rationing includes 3 important concepts: scarcity, resource limitation, and exclusion. Thus, rationing in the health sector means the limitation of resources (including funding) directed to medical services and the fair distribution of these limited resources.
In Georgia, where public health spending is limited, health rationing will help healthcare decision-makers ensure maximum benefit to the population at reasonable costs, as it is a mechanism for fair distribution of healthcare resources.
The paper aims to evaluate the existing approaches to healthcare rationing in the world and develop recommendations. Health rationing, as a strategy for setting priorities, will help health authorities identify mechanisms to allocate scarce resources cost-effectively.
The amount of medical services to be provided for seriously ill patients is a hotly debated topic. It should be noted that in the US, 27% of the Medicaid budget is spent in the last year of a person's life, and almost half of these funds are spent in the last 60 days (Hogan et al., 2001). About 67% of those who died were treated in a hospital or nursing home; 33% died at home, half of whom were involved in palliative care programs (Teno et al., 2004).
Cost containment does not always mean rationing. Uneconomical administrative and medical interventions need to be eliminated before necessary services can be rationed. When rationing truly useful services, the issue becomes even more complicated. In the case of scarce funding of the health care system, when benefits are reduced, how can one act to distribute resources as fairly as possible? In the USA, a special structure has been created to research the comparative effectiveness of medical interventions (Benner., et al. 2010).
To decide on providing or stopping medical services, the criterion of medical effectiveness is used, through which it is determined how much the treatment will maximize the benefit and minimize the harm.
If intervention A increases quality-of-life years more than intervention B, intervention A is more medically effective. In the case of medical effectiveness, the costs of the intervention are not taken into account. Cost-effectiveness analysis considers costs. If intervention A increases human life years by an appropriate degree and costs more than intervention B, then it is more cost-effective. Which is the better standard for rationing medical services: medical effectiveness or cost-effectiveness?
If the problem of scarcity of money did not arise, medical efficiency (maximization of benefits and minimization of harms) would be the ideal standard for rationing medical services (that is, the less effective the therapy, the lower its priority in the list of proposed treatment methods). But the paucity of funding forces us to ration, and ignoring costs is unrealistic. Thus, cost considerations are essential in deciding which services to ration.
For example, screening mammography is more effective than bone marrow transplantation. Therefore, when rationing medical services, it is logical to spend money on mammography than on bone marrow transplantation, because the preventive measure is more cost-effective. However, in addition to cost-effectiveness, it is important to consider ethical issues.
There are two approaches to consider when discussing the cost of different types of medical care. Breast cancer screening is more acceptable to us when we are healthy because it gives us a greater benefit at a lower cost. When we have the disease and breast cancer is in the face with metastases and terminal stage, obviously the importance of screening decreases.
In the second approach, the need for medical services for individual patients increases. In the first approach, the priority is to include the whole society, which expands the scope of medical services. As our example shows, the program that provides the most benefit to society at the lowest cost (Option 1) is not the best for the individual patient (Option 2) and vice versa. However individual patients and society represent different positions in which each of us may find ourselves at different times in our lives. Doctors generally take care of patients when they are sick (second position). But if the costs of treating those in the second position reduce the resources available to prevent disease for the much larger number of people in the first position (who may not seek medical attention because they feel better), the individual principles of beneficence and autonomy are superseded by the public principle of justice. It can be said that the choice of those in the second position violates the benefits of those in the first position. On the other hand, if all resources go to those in the first position (eg, for the cost-effectiveness of screening rather than high-tech treatment for patients with life-threatening diseases), an injustice is created for patients who have severe diseases and require expensive treatment.
There is no ideal method of rationing medical services. Using cost-effectiveness as a measure raises ethical issues, and determining the cost-effectiveness of different interventions is difficult. Every effort should be made to first control costs painlessly, and then to address the painful limitation of effective medical care. But if rationing is unavoidable, a balance must be struck between many legitimate demands: the demand for disease prevention by healthy people, the diagnosis and treatment of acute illnesses, and the obligation to provide medical care for the chronically ill.
The review shows that the economic rationality of healthcare rationing is driven by the scarcity of healthcare resources in the face of increased demand and costs. Therefore, supply, demand, and benefits are the basis of healthcare rationing and influence decisions. Given the increased costs of health care and the scarcity of resources, health rationing is essential for ensuring rational, equitable, and cost-effective distribution of healthcare resources to people. Health rationing as a strategy for setting priorities will help health authorities identify mechanisms to allocate scarce resources cost-effectively.

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Keywords: Rationing, health services, cost-effective distribution.
JEL Codes: I10, I11, I18