Doctors see benefits in healthcare rationing
By Robbie Dingeman
Advertiser Health Writer
Increasing medical costs, advances in technology and a rapidly aging population have convinced doctor-author Peter Ubel that healthcare rationing sometimes makes sense.
Ubel, associate professor at the University of Michigan and author of the book "Pricing Life" yesterday gave as an example patients with heartburn who can ease symptoms with two types of medication.
For patients without health insurance who must pay the entire cost of the medicine, their doctors may opt for the cheaper of two types of medication, he said, leaving them more money for other expenses.
Ubel also points to routine ultrasound tests on pregnant women who are exhibiting no apparent complications. He argues that the procedure is unnecessary for most people and amounts to "an expensive early baby picture."
He sees the increase in available technology as driving up the costs of healthcare, even when the technology is not always needed. Patients need to pay attention to the issue because they will pay for the higher costs, Ubel said.
About 250 doctors, nurses, social workers and educators signed up for the sixth International Bioethics Conference yesterday and today at St. Francis Medical Center, spending much of the time debating the subject of healthcare rationing.
Th conference is organized by The St. Francis International Center for Healthcare Ethics around the theme: "Setting limits to healthcare: The time is now."
Dr. S.Y. Tan, director of the St. Francis International Center for Healthcare Ethics, said some rationing already occurs throughout the United States. Without restrictions, "then everybody would get everything all the time.
"It's not whether or not we have rationing, it's whether it will be fair," Tan said. And the decision on who gets what kind of care shouldn't be based on a person's gender, race, religion, or ability to pay, Tan said.
Still, Tan recognizes that some differences occur. "The president of the United States gets a different level of healthcare than the homeless person in 'A'ala park."
Organ transplants are one area for the healthcare rationing debate. Dr. Alan Cheung, director of pancreas transplantation at St. Francis Medical Center, said 400 people are on the waiting list for an organ in Hawai'i; meanwhile there is an average of only 30 donors per year.
On one level, Cheung said, it's clear the organ should go to someone who is a good physical match and needs the organ the most. It gets more complicated as those involved strive to make the process fair, equitable and consistent.
That means a person in otherwise excellent health would rank higher on the list than someone with multiple illnesses that lessen the person's chance of survival.
Kai-Hong Phua, a leading medical economist from Singapore, said people in healthcare should be asking basic questions about treatment that can help to control costs: "Should we do it? Could we do it better and/or cheaper?"
Making such choices avoids what he calls the "buffet syndrome" where patients take more resources than they need or can use because it's there and they already paid for it.
Reach Robbie Dingeman at rdingeman@honoluluadvertiser.com or 535-2429.
