title: A survey of Ethiopian physicians' experiences of bedside rationing: extensive resource scarcity, tough decisions and adverse consequences.
abstract: BACKGROUND
  Resource scarcity in health care is a universal challenge. In high-income settings, bedside rationing is commonly discussed and debated as a means to addressing scarcity. However, little is known about physicians' experiences in resource-limited contexts in low- income countries. Here we describe physicians' experiences regarding scarcity of resources, bedside rationing, use of various strategies to save resources, and perceptions of the consequences of rationing in Ethiopia.
  
  
  METHODS
  A national survey was conducted amongst physicians from 49 public hospitals using stratified, multi-stage sampling in six regions. All physicians in the selected hospitals were invited to respond to a self-administered questionnaire. Data were weighted and analyzed using descriptive statistics.
  
  
  RESULTS
  In total, 587 physicians responded (91% response rate). The majority had experienced system-wide shortages of various types of medical services. The services most frequently reported to be in short supply, either daily or weekly, were access to surgery, specialist and intensive care units, drug prescriptions and admission to hospital (52, 49, 46, 47 and 46% respectively). The most common rationing strategies used daily or weekly were limiting laboratory tests, hospital drugs, radiological investigations and providing second best treatment (47, 47, 47 and 39% respectively). Availability of institutional or national guidelines for whom to see and treat first was lacking. Almost all respondents had witnessed different adverse consequences of resource scarcity; 54% reported seeing patients who, in their estimation, had died due to resource scarcity. Almost 9 out of 10 physicians were so troubled by limited resources that they often regretted their choice of profession.
  
  
  CONCLUSIONS
  This study provides the first glimpses of the untold story of resource shortage and bedside rationing in Ethiopia. Physicians encounter numerous dilemmas due to resource scarcity, and they report they lack adequate guidance for how to handle them. The consequences for patients and the professionals are substantial.
authors.affiliation: Research Group in Global Health Priorities, Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 21, 5018, Bergen, Norway. frehiwot.berhane@gmail.com.
authors.forename: Frehiwot Berhane
authors.initials: FB
authors.lastname: Defaye
authors.affiliation: College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia. mdawitd@gmail.com.
authors.forename: Dawit
authors.initials: D
authors.lastname: Desalegn
authors.affiliation: Department of Bioethics, National Institute of Health, Bethesda, USA. mdanis@cc.nih.gov.
authors.forename: Marion
authors.initials: M
authors.lastname: Danis
authors.affiliation: Institute for Ethics, History, and the Humanities, Geneva University Medical School, Geneva, Switzerland. samia.hurst@unige.ch.
authors.forename: Samia
authors.initials: S
authors.lastname: Hurst
authors.affiliation: Addis Continental Institute of Public Health, Addis Ababa, Ethiopia. yemaneberhane@ethionet.et.
authors.forename: Yemane
authors.initials: Y
authors.lastname: Berhane
authors.affiliation: Research Group in Global Health Priorities, Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 21, 5018, Bergen, Norway. ole.norheim@uib.no.
authors.forename: Ole Frithjof
authors.initials: OF
authors.lastname: Norheim
authors.affiliation: Research Group in Global Health Priorities, Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 21, 5018, Bergen, Norway. Ingrid.miljeteig@uib.no.|Department of Research and Development, Helse Bergen Health Trust, Bergen, Norway. Ingrid.miljeteig@uib.no.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Miljeteig
mesh_terms: D000328:Adult; D003695:Delivery of Health Care; D005002:Ethiopia; D005260:Female; D015276:Health Care Rationing; D019538:Health Care Surveys; D006295:Health Resources / Q000600:supply & distribution*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010465:Perception; D010820:Physicians / Q000523:psychology*; D013038:Specialization; D011795:Surveys and Questionnaires; D055815:Young Adult