Making Medical Spending Decisions: The Law, Ethics and Economics of Rationing Mechanisms.

Hall, Mark A. New York: Oxford University Press, 1997.

One of the most fundamental issues in health care delivery is who should decide which items of medical care are not worth their cost. This book is a fresh and comprehensive exploration of how health care rationing decisions are made. Unlike prior works, its focus is not on the specific criteria for rationing, like age or quality of life. Instead, the author provides a comparative analysis of alternative social mechanisms for making medical spending decisions: (1) consumers paying for their medical treatment out of pocket; (2) insurers, government officials, or other centralized authorities setting limits on what doctors can do and what insurance will pay for; and (3) physicians motivated to make these decisions at the bedside level. His analysis of each of these mechanisms reveals that none is uniformly superior and each is better suited for certain decisions than others. Therefore, a mix of all three is inevitable.

Throughout the book the...