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The political economy of rationing health care in England and the US: the ‘accidental logics’ of political settlements

Published online by Cambridge University Press:  23 April 2014

Gwyn Bevan  and
Lawrence D. Brown
Gwyn Bevan*
Affiliation:
Department of Management, London School of Economics, UK
Lawrence D. Brown
Affiliation:
Deparment of Health Policy and Management, Mailman School of Public Health, Columbia University, USA
*
*Corresponding to: Gwyn Bevan, Department of Management, London School of Economics and Political Science, Houghton Street, WC2A 2AE London. Email: R.G.Bevan@lse.ac.uk
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Abstract

This article considers how the ‘accidental logics’ of political settlements for the English National Health Service (NHS) and the Medicare and Medicaid programmes in the United States have resulted in different institutional arrangements and different implicit social contracts for rationing, which we define to be the denial of health care that is beneficial but is deemed to be too costly. This article argues that rationing is designed into the English NHS and designed out of US Medicare; and compares rationing for the elderly in the United States and in England for acute care, care at the end of life, and chronic care.

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Type
Special Section
Information
Health Economics, Policy and Law , Volume 9 , Issue 3 , July 2014 , pp. 273 - 294
Copyright
© Cambridge University Press 2014 

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