PubMed · 10168049
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L J Weber, M G Bissell. Case studies in ethics. Modifying physician behavior.. https://pubmed.ncbi.nlm.nih.gov/10168049/
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OBJECTIVE: To examine the methods used by policy makers to try to reduce or limit expenditure within the National Health Service. METHOD: A chronological examination of cost related health care policy and its wider impact on society. Comparison of past developments in the NHS with new methods of health care organisation in the United Kingdom (UK). The experiences of two dental Total Purchasing Pilots are used to describe where the dental profession now stands in relation to current NHS developments. RESULTS: The introduction of Primary Care Groups (PCGs) constitutes part of a continued effort by health care policy makers to control expenditure on health services. In the PCG system, as in Total Purchasing (TP), a group of primary care practitioners control a finite budget. These groups therefore must decide which health care services should be available to the population they represent. Inevitably such systems result in the rationing of health care, but the decisions are instigated by primary health care professionals rather than by government edict. CONCLUSION: Unless GDPs are allowed, willing and able, to participate in and influence the newly emerging Primary Care Groups and Trusts, dental services may once again be pushed to the fringe of NHS care provision. Without adequate representation, the value of dental care may not be recognised and PCGs may decide to make use of traditional dental resources, to fund other services.
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There has been much debate about cost-cutting in health care. In this context, the term rationing means that acceptable services and measures with proven benefit are subject to limited allocation (or complete refusal thereof) due to a shortage of resources. After an introductory discussion about the "terminology" of rationing, achievements in premium health care will be critically elucidated in this regard. Chapter 2 focuses on the question of whether age is a valid criterion for the rationing of surgical care. Chapter 3 critically analyses the "societal solution" to the rationing problem. The way to solve society's tendency to become insatiable (pleonexia) is the same as the way to solve the shortage of resources, i.e. by "circumspection" or "moderation" on the part of each individual (sophrosyne).