Skip to main content
×
Home

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

  • Gwyn Bevan (a1) and Lawrence D. Brown (a2)
Abstract
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.

Copyright
Corresponding author
*Corresponding to: Gwyn Bevan, Department of Management, London School of Economics and Political Science, Houghton Street, WC2A 2AE London. Email: R.G.Bevan@lse.ac.uk
References
Hide All
Aaron H. J. and Schwartz W. B. (1984), The Painful Prescription, Washington, DC: Brookings Institution.
Aaron H. J., Schwartz W. B. and Cox M. (2005), Can We Say No? The Challenge of Rationing Health Care, Washington, DC: Brookings Institution.
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): 89105.
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: 903914.
Arrow K. J. (1963), ‘Uncertainty and the welfare economics of medical care’, American Economic Review, 53: 941973.
Barr N. and Diamond P. (2006), ‘The Economics of Pensions’, Oxford Review of Economic Policy, 22(1): 1539.
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): 851862.
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, 4461.
Bernstein N. (2012), ‘With Medicaid, Long-Term Care of Elderly Looms as Rising Cost’, New York Times, 7 September.
Bevan A. (1978), In Place of Fear, London: Quartet.
Bevan G. (2009), ‘The search for a proportionate care law by formula funding in the English NHS’, Financial Accountability and Management, 25(1): 391410.
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): 517538.
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): 5378.
Brown L. D. (2011), ‘The elements of surprise: how health reform happened’, Journal of Health Politics, Policy and Law, 36(3): 419427.
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): 587609.
Brown L. D. (2012b), ‘Stealing On Insensibly’: end-of-life politics in the United States’, Health Economics, Policy and Law, 7(4): 467483.
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].
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].
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].
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.
Daniels N. (1990), Just Health Care, Cambridge: Cambridge University Press.
Daniels N. (2003), ‘Democratic equality: Rawls’s complex egalitarianism’, in S. Freeman (ed.) The Cambridge Companion to Rawls, Cambridge: Cambridge University Press, 241276.
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].
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].
Dworkin R. (1992), ‘Justice in the distribution of health care’, McGill Law Journal, 38: 883898.
Dworkin R. (2000), Sovereign Virtue: The Theory and Practice of Equality, London: Harvard University Press.
Eichner J. and Vladeck B. C. (2005), ‘Medicare as a catalyst for reducing health disparities’, Health Affairs, 24(2): 365375.
Evans R. G. (1987), ‘Public health insurance: the collective purchase of individual care’, Health Policy, 7: 115134.
Faden R. R. and Chalkidou K. (2011), ‘Determining the value of drugs – the evolving British experience’, The New England Journal of Medicine, 364: 12891291.
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].
Fradkin J. E. (2012), ‘Confronting the urgent challenge of diabetes: an overview’, Health Affairs, 31(1): 1219.
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].
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): 537543.
Gray B. H. (2011), England’s Approach to Improving End-of-Life Care: A Strategy for Honoring Patients’ Choices, New York: Commonwealth Fund.
House of Commons, Public Accounts Committee (2009), End of Life Care. Nineteenth Report of Session 2008–09, London: Stationary Office.
Jost T. S. (2014), ‘Implementing health reform: four years later’, Health Affairs, 33(1): 710.
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.
Kaiser Family Foundation (2011), Medicare Spending and Financing, Washington, DC: The Henry J. Kaiser Family Foundation.
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].
Klein R. (2010), The New Politics of the NHS: From Creation to Reinvention, 6th edition, London: Radcliffe.
Klein R. and Maybin J. (2012), Thinking About Rationing, London: King’s Fund.
Marmor T. (2000), The Politics of Medicare, second edition, New York: Aldine de Gruyter.
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, 3752.
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, 5388.
Morgan S. and Kennedy J. (2010), Prescription Drug Accessibility and Affordability in the United States and Abroad, New York: The Commonwealth Fund.
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].
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].
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].
NHS Choices (2014), Your health, your way. http://www.nhs.uk/planners/yourhealth/pages/prescriptioncosts.aspx [30 March 2014].
Neumann P. J. and Weinstein M. C. (2010), ‘Legislating against use of cost-effectiveness information’, New England Journal of Medicine, 363: 14951497.
Newhouse J. P. (1993), ‘An iconoclastic view of health cost containment’, Health Affairs, 12(Supplement): 152171.
OECD (2011), Health at a Glance 2011. http://www.oecd.org/els/health-systems/49105858.pdf [30 March 2012].
OECD (2013a), Health at a Glance 2013. http://www.oecd.org/els/health-systems/Health-at-a-Glance-2013.pdf [30 March 2012].
OECD (2013b), OECD Health Data 2013. http://stats.oecd.org/Index.aspx?DataSetCode=SHA [30 March 2012].
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].
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].
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.
Reinhardt U. E., Hussey P. S. and Anderson G. F. (2004), ‘U.S. health care spending in an international context’, Health Affairs, 23: 310325.
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].
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].
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].
Secretary of State for Health (2010), Equity and Excellence: Liberating the NHS. Cm7881, London: Department of Health.
Skinner J. (2011), ‘Understanding prices and quantities in the US health care system’, Journal of Health Politics, Policy and Law, 36(4): 791801.
Smith S., Newhouse J. P. and Freeland M. S. (2009), ‘Income, insurance, and technology: why does health spending outpace economic growth?Health Affairs, 28: 12761284.
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: 179189.
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: 19771981.
Thorlby R. and Maybin J. (2010), A High-Performing NHS? A Review of Progress 1997–2010, London: The King’s Fund.
Timmins N. (2012), Never Again? The story of the Health and Social Care Act 2012, London: King’s Fund and Institute for Government.
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.
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].
Webster C. (1988), The Health Services Since the War. Volume I. Problems of the National Health Service Before 1957, London: HMSO.
Webster C. (ed.) (1991), Aneurin Bevan on the National Health Service, Oxford: University of Oxford.
Williams A. (1985), ‘The economics of coronary artery bypass grafting’, BMJ, 291: 326329.
Williams A. (1997), ‘Equity: intergenerational equity: an exploration of the ‘fair innings’ argument’, Health Economics, 6(2): 117132.
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: 22692276.
Zweifel P., Felder S. and Meiers M. (1999), ‘Ageing of population and health care expenditure: a red herring?’, Health Economics, 8(6): 485496.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Health Economics, Policy and Law
  • ISSN: 1744-1331
  • EISSN: 1744-134X
  • URL: /core/journals/health-economics-policy-and-law
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 21
Total number of PDF views: 53 *
Loading metrics...

Abstract views

Total abstract views: 328 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 18th November 2017. This data will be updated every 24 hours.