Chapter 41: CBA and Equity II: Allocating by Time and Other Non-Price Methods
As a complete alternative to allocating health care resources by willingness to pay and cost, non-economists often recommended using time as the basis for rationing (that is, restricting consumption of health care). They think this is fairer than using market-type principles. Much of the National Health Service (NHS) in the United Kingdom relies (or used to rely) on this system. So if one wants to see the local physician, one needs to wait one’s turn at the doctor’s offices. Rationing here is on a “first-come, first-served basis”. How long you are willing to wait is an indicator of how important it is for you to see the doctor. Similarly, to have a nonemergency operation, there is a waiting list. If you want the operation free of charge, you must be willing to wait weeks, months, or possibly, years till your turn comes up. In this chapter we will examine the effects and implications of using time as a rationing system. This discussion is very general and relates to any type of rationing of health care by using time. To consider particular issues that are specific to HIV/AIDS rationing, we will also cover other non-price rationing methods that are applicable to the dispensing of ARV therapy in Africa, based on some of the ideas given in Rosen et al. (2005). RATIONING HEALTH CARE USING TIME If health services are to be given free of charge, it is almost inevitable that the quantity demanded is going to exceed the quantity supplied and...
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