"Ruling in" and "ruling out" : Two approaches to the micro-rationing of health care.
Much of the implicit rationing said to characterise British health care occurs as doctors decide what resources to allocate to individual patients.
This paper examines this process using data from case studies of selection of patients for cardiac surgery and admission to a specialist neurological rehabilitation centre.
The analysis focuses on cardiac catheterisation conferences in which cardiologists present surgical candidates to a cardiac surgeon, and neuro-rehabilitation admissions conferences in which a multidisciplinary team assess the suitability of head injury and stroke patients referred by hospital doctors.
For much of the time participants in both settings discuss patients within a clinical discourse that relies on technical assessments of coronary anatomy, ADL scores and the like.
However, there are many examples where the discourse « frame » shifts to address patient characteristics of a social or moral nature.
Information of this kind tends to be deployed in two ways : it can be used to signal the patient's unsuitability, usually on the basis that past behaviour implies poor prognosis ( « ruling out »), or it can be used to suggest that a patient is especially deserving of help ( « ruling in »). Analysis of the data suggests that « ruling out » is more salient within the cardiac catheterisation conferences, and « ruling in » within the neuro-rehabilitation admissions conferences. (...)
Mots-clés Pascal : Rationnement, Soin, Prise décision, Médecin, Personnel sanitaire, Hôpital, Critère sélection, Malade, Discussion, Chirurgie, Coeur, Réhabilitation, Royaume Uni, Europe, Appareil circulatoire pathologie, Système santé, Homme, Economie santé
Mots-clés Pascal anglais : Rationing, Care, Decision making, Physician, Health staff, Hospital, Selection criterion, Patient, Discussion, Surgery, Heart, Rehabilitation, United Kingdom, Europe, Cardiovascular disease, Health system, Human, Health economy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0238146
Code Inist : 002B30A01B. Création : 11/06/1997.