Approaches to Rationing Drugs in Hospitals
- 6 Downloads
The increasing need to consider rationing strategies within the healthcare environment is being driven by pressures such as the development of new medical technologies, the aging population, patient awareness and expectations, healthcare professionals’ appetite for new treatments, and government restrictions on healthcare costs. Solutions to these pressures will need to be sought urgently to avoid a situation in which quality of healthcare is affordable only for the wealthy. The fundamental principles of equity and fairness will need to be applied universally if the solutions are to be accepted by the community, patients and practitioners.
There are several measures that a hospital must have in place before the concept of drug rationing can be contemplated. The approach essentially involves ensuring rational drug approval processes based on critical review of the available data, coupled with ongoing education and audit. Thus, accurate information and clinical budgeting systems, processes which encourage and ensure structural and technical efficiencies within the drug use sequence and an effective Drug and Therapeutics committee are required to facilitate this approach.
To assist with its overriding goals of the quality use of medicines and optimal patient care, the Drug and Therapeutics committee needs to implement an effective formulary system, obtain detailed guidelines governing drug use within the institution, conduct an ongoing drug utilisation review programme, and provide education and training.
The move to consider allocative decision making (rationing) will become increasingly necessary as limits on structural and technical efficiency measures are reached. An institution will then need to decide whether to treat a particular group of patients, or provide a certain form of treatment. Improved methods for community consultation need to be explored and there must be a partnership between the health provider and the consumer in enunciating the existence of scarcity, determining priorities and ensuring that ethics and equity are not abandoned through this process.
KeywordsPriority Setting Drug Rationing Allocative Efficiency Optimal Patient Care Royal Adelaide Hospital
Unable to display preview. Download preview PDF.
- 3.Leeder SR. Cost cutting without blood spilling. Hosp Health Care Aust 1989; 20: 16, 18, 30Google Scholar
- 5.Larkins R. Patient care when medical resources are scarce. Aust Med 1989; 1: 377–9Google Scholar
- 7.Bates EM, Lindner-Pelz S. The ethics of rationing health care. In: Health care issues. Sydney (NSW): Allen and Unwin, 1987: 131–42Google Scholar
- 16.Pearce MJ, Begg EJ. Hospital drug therapy cost containment through a preferred medicines list and drug utilisation review system. NZ Med J 1994; 107 (974): 101–4Google Scholar
- 23.Maguire TM, Petrie G. A hitchhiker’s guide to establishing a drug utilisation evaluation program. Aust J Hosp Pharm 1995; 25: 315–24Google Scholar
- 24.Carpenter CE, Nash DB, Johnson NE. Evaluating the cost containment potential of clinical guidelines. Qual Rev Bull 1993: 119–23Google Scholar
- 28.Sanchez LA. Conducting pharmacoeconomic evaluations in a hospital setting. Hosp Pharm 1995; 30 (5): 415–6, 428Google Scholar
- 31.Pillans PI. Control of high cost medicines. NZ Med J 1994; 107 (974): 5–6Google Scholar