ⓘ Health care rationing. In the United Kingdom, the National Institute for Health and Care Excellence NICE sets coverage requirements for the National Health Serv ..


ⓘ Health care rationing

In the United Kingdom, the National Institute for Health and Care Excellence NICE sets coverage requirements for the National Health Service NHS, which is funded and operated by the government. NICE calculates an incremental cost-effectiveness ratio in terms of quality-adjusted life years QALY. Treatments under £20.000 per QALY gained are considered cost-effective, but those above £30.000 per QALY are rarely approved. Individuals who are able to do so may also pay for private treatments beyond what the NHS offers, but low-income people largely have equal access to health care. The overall level of government funding for NHS is a political issue in the UK. Local decisions about service provision in England are made by Clinical commissioning groups.

As pressures on the NHS have increased there have been increasing local moves to restrict non urgent surgery for obese patients and smokers. Funding for In vitro fertilisation is reduced from three cycles to one for patients who meet the criteria; that female sterilisation is only be funded in exceptional circumstances; gluten free food will not be available on prescription for most patients who need it; and over the counter medicines will no longer be prescribed except in exceptional circumstances.

In 2006 Croydon Primary Care Trust produced a list of 34 procedures of limited clinical effectiveness which was circulated widely within the English NHS. Some were largely cosmetic, and others were used on patients who were unlikely to benefits from them. The London Health Observatory calculated that these procedures amounted to between 3% and 10% of clinical activity and that the resources could be used more effectively. A similar list was produced by NHS England in June 2018. It is proposed that surgery for snoring, dilatation and curettage for heavy menstrual bleeding, knee arthroscopies for osteoarthritis and injections for non-specific back pain will only be available in exceptional circumstances.

Specific eligibility criteria will be produced for

  • Tonsillectomy for sore throats
  • Breast reduction
  • Carpal tunnel syndrome release
  • Grommets for Glue Ear
  • Removal of benign skin lesions
  • Haemorrhoid surgery
  • Varicose vein surgery
  • Anthroscopic compression for subacromial shoulder pain
  • Dupuytrens contracture release for tightening of fingers
  • Trigger finger release
  • Hysterectomy for heavy menstrual bleeding
  • Chalazia lesions on eyelids removal
  • Ganglion excision - removal of noncancerous lumps on the wrist or hand

This would affect about 100.000 patients every year and is claimed to free up about £200 million.

See also NHS treatments blacklist.


1. Shortages

Shortages of donated organs for transplantation has resulted in the rationing of hearts, livers, lungs and kidneys in the United States, mediated by the United Network for Organ Sharing. During the 1940s, a limited supply of iron lungs for polio victims forced physicians to ration these machines. Dialysis machines for patients in kidney failure were rationed between 1962 and 1967. More recently, Tia Powell led a New York State Workgroup that set up guidelines for rationing ventilators during a flu pandemic. Among those who have argued in favor of health care rationing are moral philosopher Peter Singer and Oregon governor John Kitzhaber.

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  • spending and ration treatments, which is one function of the National Institute for Health and Care Excellence NICE arguing that rationing by market pricing
  • receiving less expensive health care which suggests that health care is being rationed in Germany based on age, rationing being illegal and potentially
  • reform, incentives that reward more care instead of better care redundant payment systems, tax policy, rationing a shortage of doctors and nurses, intervention
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  • networks. Health care administrators are considered health care professionals. Health policy and management or health systems management or health care systems
  • Health care in the United States is provided by many distinct organizations. Health care facilities are largely owned and operated by private sector businesses
  • The Clinton health care plan was a 1993 healthcare reform package proposed by the administration of President Bill Clinton and closely associated with
  • National Institute for Health and Care Excellence NICE is an executive non - departmental public body of the Department of Health in the United Kingdom
  • 2009 Why We Must Ration Healthcare The New York Times. Retrieved May 4, 2010. PolitiFact, There s rationing in health care now, and there still
  • The Affordable Health Care for America Act or HR 3962 was a bill that was crafted by the United States House of Representatives in October 29 of 2009