How Physicians Allocate Scarce Resources at the Bedside: A Systematic Review of Qualitative Studies


Abstract
Although rationing of scarce health-care resources is inevitable in clinical practice, there is still limited and scattered information about how physicians perceive and execute this bedside rationing (BSR) and how it can be performed in an ethically fair way. This review gives a systematic overview on physicians’ perspectives on influences, strategies, and consequences of health-care rationing. Relevant references as identified by systematically screening major electronic databases and manuscript references were synthesized by thematic analysis. Retrieved studies focused on themes that fell under three major headings: (i) conditions and influences of BSR, (ii) strategies of BSR, and (iii) consequences of BSR. The range of themes indicates that physicians’ rationing behavior is highly variable, strongly influenced by context-related factors, and consists mainly of implicit rationing strategies. Torn between patient advocacy and the obligation to contain costs, physicians experience various role conflicts. The development of explicit rationing strategies seems necessary to avoid arbitrary BSR and allow a fair allocation of health-care resources
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DOI 10.1093/jmp/jhm007
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References found in this work BETA

Trust and the Ethics of Health Care Institutions.Susan Dorr Goold - 2001 - Hastings Center Report 31 (6):26-33.
Medical Decision Making in Scarcity Situations.J. J. M. van Delden - 2004 - Journal of Medical Ethics 30 (2):207-211.

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How to Write a Systematic Review of Reasons.D. Strech & N. Sofaer - 2012 - Journal of Medical Ethics 38 (2):121-126.
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