Education And Debate

Controversies in Treatment: How can hospitals ration drugs? Drug rationing in a teaching hospital: a method to assign priorities

BMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6933.901 (Published 02 April 1994) Cite this as: BMJ 1994;308:901
  1. F BochnerE D MartinN G BurgessA A SomogyiGary M H Misan on behalf of the Drug Committee of the Royal Adelaide Hospital
  1. Royal Adelaide Hospital, North Terrace, Adelaide, Australia 5000 University of Adelaide, Adelaide, Australia 5005
  2. Department of Clinical and Experimental Pharmacology Health Economics Research Unit, University of Aberdeen, Aberdeen AB9 2ZD
  3. Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen AB9 2ZD
  4. Centre for Professional Ethics, University of Central Lancashire, Preston PR1 2HE
  • Accepted 13 December 1993

When drug budgets are unable to accommodate all new drug requests, a dilemma arises when additional funds become available - which drugs should receive priority? The drug committee at Royal Adelaide Hospital devised a scheme, which they describe here, to rank drug requests to obtain the greatest benefit for the most patients for each dollar spent. We asked a health economist, a clinical pharmacologist, and a moral philosopher to give their perspectives on this form of rationing, and we then gave the authors an opportunity to respond.

The cost of all aspects of health care in developed countries is increasing at an alarming rate.1 Meeting these costs is becoming more difficult, and a variety of cost containment measures is being considered at national and regional levels.2,3 The continuing introduction of new technologies and drugs is one of the factors in the escalating cost of health care. These new treatments are often incompletely evaluated, and estimates of cost-benefit are lacking or poorly documented. This situation has resulted in a vigorous debate about the need for, ethics of, and possible methods for cost containment and rationing of health services.*RF 4-8*

Hospitals have responded to shrinking financial resources by increasing day patient or outpatient services; transferring outpatient services to the community; imposing waiting lists; making services available only as long as funds are available; and withdrawing some services altogether. The last two options, and to some extent the imposition of waiting lists, are usually unplanned since cuts in hospital or divisional budgets often occur with little warning, and they can be regarded as arbitrary and unfair. Those patients who are excluded from the curtailed or reduced service are often those who were the last to join the queue.

The Royal Adelaide Hospital is a tertiary referral hospital of about 900 beds. …

View Full Text

Sign in

Log in through your institution

Free trial

Register for a free trial to thebmj.com to receive unlimited access to all content on thebmj.com for 14 days.
Sign up for a free trial

Subscribe