The political economy of rationing health care in England and the US: the 'accidental logics' of political settlements.
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.
1Department of Management,London School of Economics,UK.
Gwyn
G
Bevan
2Deparment of Health Policy and Management,Mailman School of Public Health,Columbia University,USA.
Lawrence D
LD
Brown
D000208:Acute Disease; D002908:Chronic Disease; D003431:Cross-Cultural Comparison; D003695:Delivery of Health Care / Q000191:economics* / Q000458:organization & administration / Q000592:standards; D004739:England; D015276:Health Care Rationing / Q000191:economics* / Q000458:organization & administration; D005102:Health Expenditures / Q000706:statistics & numerical data; D006291:Health Policy / Q000191:economics*; D006299:Health Services for the Aged / Q000191:economics* / Q000458:organization & administration; D006801:Humans; D008484:Medicaid / Q000191:economics / Q000458:organization & administration; D006278:Medicare / Q000191:economics / Q000458:organization & administration; D011057:Politics; D013222:State Medicine / Q000191:economics* / Q000458:organization & administration; D013727:Terminal Care / Q000191:economics* / Q000458:organization & administration / Q000592:standards; D014481:United States