This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

E. Haavi Morreim, PhD

Arch Intern Med. 1989;149(5):1012-1015.

Abstract
• Until recently, generous third-party reimbursements enabled physicians to pursue each patient's interests with little regard to costs. Conscious rationing was required only episodically as some particular commodity, eg, transplant organs, was too scarce to meet demand, or as some patients lacked basic access to the health care system. Cost containment and the economic reorganization of medicine introduce a new sort of scarcity, requiring a different sort of rationing. "Fiscal scarcity," the general contraction of health care dollars, means that because every medical decision has its cost, every decision is now subject to scrutiny for its economic as well as its medical wisdom. Therefore, every detail of medicine is an allocation problem. Many observers argue that physicians can nevertheless avoid directly trading patients' interests against economic considerations: through "efficiency protocols" that eliminate marginal benefits, through turning economic rationing decisions over to outside parties, through avoiding cost constraints until society has established a just health care allocation system. This article shows that none of these proposals permits the physician to escape cost-cutting at the bedside.

(Arch Intern Med. 1989;149:1012-1015)

Author Affiliations
From the Department of Human Values and Ethics, College of Medicine, University of Tennessee, Memphis.

Footnotes
Accepted for publication December 21, 1988.

Reprints not available.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Should ethics consultants help clinicians face scarcity in their practice?
Hurst et al.
J. Med. Ethics 2008;34:241-246.
ABSTRACT | FULL TEXT  

Cancer Care, Money, and the Value of Life: Whose Justice? Which Rationality?
Sulmasy
JCO 2007;25:217-222.
ABSTRACT | FULL TEXT  

Physicians' Responses to Resource Constraints
Hurst et al.
Arch Intern Med 2005;165:639-644.
ABSTRACT | FULL TEXT  

The Costs of Denying Scarcity
Alexander et al.
Arch Intern Med 2004;164:593-596.
FULL TEXT  

Support for Physician Deception of Insurance Companies among a Sample of Philadelphia Residents
Alexander et al.
ANN INTERN MED 2003;138:472-475.
ABSTRACT | FULL TEXT  

Caring and Cost: The Challenge for Physician Advocacy
Pearson
ANN INTERN MED 2000;133:148-153.
ABSTRACT | FULL TEXT  

Lying for Patients: Physician Deception of Third-Party Payers
Freeman et al.
Arch Intern Med 1999;159:2263-2270.
ABSTRACT | FULL TEXT  

Truth or Consequences
Levinsky
NEJM 1998;338:913-915.
FULL TEXT  

Fair Allocation of Intensive Care Unit Resources
Am. J. Respir. Crit. Care Med. 1997;156:1282-1301.
FULL TEXT  

The Unbearable Rightness of Bedside Rationing: Physician Duties in a Climate of Cost Containment
Ubel and Arnold
Arch Intern Med 1995;155:1837-1842.
ABSTRACT  

Should the Health Care Forest Be Selectively Thinned by Physicians or Clear Cut by Payers?
Welch
ANN INTERN MED 1991;115:223-226.
ABSTRACT  

Gaming the System: Dodging the Rules, Ruling the Dodgers
Morreim
Arch Intern Med 1991;151:443-447.
ABSTRACT  

Quality-Adjusted Life-Years: Ethical Implications for Physicians and Policymakers
La Puma and Lawlor
JAMA 1990;263:2917-2921.
ABSTRACT  

Conflicts of Interest: Profits and Problems in Physician Referrals
Morreim
JAMA 1989;262:390-394.
ABSTRACT