The health care resource allocation debate. Defining our terms
D. C. Hadorn and R. H. Brook
Department of Social Policy, RAND, Santa Monica, CA 90406.
The problem of health care distribution in the United States demands
immediate action. Many different solutions have been proposed to slow
rising health care costs and to improve access to care for the poor and
uninsured. Debate among proponents of these various proposals might be
advanced if a common language were adopted with regard to certain key terms
instead of the various meanings currently assigned to these terms. For this
reason, we propose and defend the following three definitions: (1)
rationing is the societal toleration of inequitable access to health
services acknowledged to be necessary by reference to necessary-care
guidelines; (2) health care needs are desires for services that have been
reasonably well demonstrated to provide significant net benefit for
patients with specified clinical conditions; and (3) basic benefit plans
are insurance packages that provide for all and only acknowledged health
care needs, again by reference to appropriate clinical guidelines.
