The DOI matches its Crossref record; 33 of the 33 references it cites were found in a registry or an index.
“Ruling in” and “ruling out”: Two approaches to the micro-rationing of health care
Abstract
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. The authors suggest that this reflects differences in the work organisation of the two specialties, including the division of labour, the organisation of waiting lists as a queue or a pool, and the putative significance of patient agency in the genesis of disease and recovery.
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Clinical decisions may rest on often implicit social criteria about which patients ought to receive care.
“As Hughes and Griffiths [61] identify, clinical decisions may rest on often implicit social criteria about which patients “ought” to receive care”
From Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups (2006) · cites this paper as [61]
Perceptions of social deservingness may play a role in adjudications.
“In addition, perceptions of social “deservingness” may play a role [61,62].”
From Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups (2006) · cites this paper as [61]
Hughes and Griffiths' paper on micro-rationing of healthcare was a key paper in helping to generate the construct of candidacy that later came to unify the themes of our analysis.
“Hughes and Griffiths' paper on micro-rationing of healthcare [61], for example, was a key paper in helping to generate the construct of candidacy that later came to unify the themes of our analysis.”
From Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups (2006) · cites this paper as [61]
Citations
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Flagged first, then by citations
Research works printed but not linked: 1
- Brindle, 1995, Secret summit plans rationing for NHS, The Guardian, 1
Cited by
Sorted by citations
Dixon-Woods, M., Cavers, D., Agarwal, S., Annandale, E., Arthur, A., Harvey, J., Hsu, R., Katbamna, S., Olsen, R., Smith, L., et al. (2006) · BMC Medical Research Methodology · doi:10.1186/1471-2288-6-35 · Cited by 2,289
Metadata
- Authors
- Hughes, D., & Griffiths, L.
- Affiliations
- Swansea University (GB)
- ORCID
- Hughes, David
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 1997-03
- Volume
- 44
- Issue
- 5
- Pages
- 589-599
- ISSN
- 0277-9536 (ISSN-L)
- OpenAlex
- W2019262191
- Cited by
- 77
- References
- 33
- Citations by year
- 2023: 3 · 2022: 1 · 2020: 2 · 2019: 2 · 2018: 3 · 2017: 2 · 2016: 1 · 2015: 3 · 2013: 5 · 2012: 4
- FWCI
- 2.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Services Management and Policy
- Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Challenges
- Health Sciences › Health Professions › General Health Professions › Health, Medicine and Society
- Keywords
- implicit rationing, healthcare resource allocation, multidisciplinary team decision-making, medical discourse, division of labor, waiting lists, patient agency, United Kingdom health system
- MeSH terms
- Adult, Attitude of Health Personnel, Cardiology, Decision Making, Female, United Kingdom, Cardiac Surgical Procedures, Humans, Male, Middle Aged, Nervous System Diseases, Patient Care Team, Patient Compliance, Prognosis, Referral and Consultation, Rehabilitation Centers, Social Perception, Waiting Lists, Health Care Rationing, Patient Selection
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