Medically necessary but not equally accessible? Priority-setting and rationing in healthcare

Written by Földes Mária Éva

Member States of the European Union have committed themselves to preserve the principles of solidarity and equity in access to needs-based healthcare as underlying values of their health systems. These values are also reflected in the traditional medical ethics according to which healthcare professionals should ensure that the patient receives all health services that are medically necessary. Solidarity-based health systems are however confronted with the challenge to meet rising costs of health services with limited resources. Efforts to ensure more efficient allocation of scarce resources raise the issue of priority-setting and rationing in healthcare, which create ’winners’ and ’loosers’ among patients and are therefore hard to legitimate. Priority-setting is a serious challenge for all healthcare systems aiming at reconciling cost-efficiency and equity. This challenge is particularly pressing for Member States of Central and Eastern Europe who strive to catch up with economic and budgetary requirements set by the European Union while preserving the basic values of their solidarity-based health systems. Existing experience from several European countries shows that priority-setting is influenced by the underlying values of the health system of a given country and by the content of the right to healthcare in particular. This paper provides an overview of controversial questions pertaining to priority-setting and rationing in healthcare with particular focus on Hungary and Romania. It analyses the content of the right to healthcare in the two countries under review, and discusses current and expected developments with particular focus on the role of medical professionals in addressing the issue of healthcare priority-setting and rationing.


Keywords: health care rationing, priority setting, equity in medical treatment, experiences from Hungary and Romania

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