Treatment of Coronary Artery Disease: What Does Rationing Do?

Brookings Policy Brief Series-December 2005
Policy Brief #148
December 2005
Aaron, H.J.

Providing all beneficial care to those who need it is rapidly becoming unaffordable, even for a nation as rich as the United States. The highly decentralized U.S. payment system is unique in its lack of effective levers for limiting health care spending, and managed care has largely been ineffective. A different solution, considered extreme by many in the United States, is rationing.

The need to ration healthcare has long been a reality in the United Kingdom where healthcare spending must be covered by an annual budget accounting for only 7.6 percent of GDP—about half the U.S. share. These decisions are perhaps most difficult in regards to treatment of conditions that are literally matters of life or death, such as coronary artery disease.

This brief examines reasons for the differences in treatment and outcomes in the United States and Britain, and discusses the difficulty of rationing care in the United States, where a unique payment system now uses income from those with health insurance to cover the medical costs of the uninsured.

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