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Health care rationing

Health care rationing refers to the practice of limiting access to medical care due to insufficient resources or funding, affecting who receives treatment and at what point. This can arise in various health care systems, including government-run programs and free market systems like that of the United States. Rationing typically occurs when the demand for medical services exceeds the available supply, prompting decisions about how to prioritize care. Common examples include insurance policies that impose prior authorizations, annual visit limits, or high deductibles, which can restrict access based on financial considerations. Rising health care costs, driven by new technologies, increased demand, and the complexities of emergency care provision, have intensified concerns about rationing. Critics often associate rationing with government health care systems, fearing bureaucratic decisions may deny care to vulnerable populations. Conversely, proponents argue that current forms of rationing in private health systems also impact access, effectively raising the question of equity in health care delivery. The ongoing debate about health care reform, including universal coverage, continues to highlight the challenges of balancing cost, access, and quality of care.

Full Article

Health care rationing is the practice of restricting the amount or level of medical care available to a person or group of people. It is most often thought of in terms of government-run programs that refuse to allow certain procedures or treatments for some or all of the people they cover. However, experts argue that health care rationing occurs in many forms and in nearly every health care system, including a free market system like the one in the United States.

Background

Rationing is a practice that calculates how far an available service or item will go and makes rules about how to distribute it. It is typically implemented when demand exceeds supply. For example, during World War II (1939–1945), food items such as sugar, meat, and butter were rationed, as was gasoline. These items were needed to provide for American soldiers and those directly affected by the war overseas, so the government limited how much people in America could purchase to make sure everyone got something, and no one had significantly more than anyone else did.

There can also be more need for health care than there are available services or supplies. This is often the case in underdeveloped countries, where people may live in remote areas with few or no advanced medical services available. In these areas, people may die or suffer unnecessarily because doctors and hospitals are not available. Yet, this is not considered rationing because the care is not available at all, and it is not being restricted intentionally.

Health care rationing usually refers to situations in which health care is available but is limited for some reason; the care is usually available, but the funds to pay for it are not. This leads to restrictions on who can get care, when they can get it, or what care is accessible based on the amount of money available to pay for it. Care can also be restricted so that the available pool of money can be directed toward services thought to provide greater benefits or a higher chance of success.

As health care costs increased due to emerging technologies, advanced procedures, and pharmaceuticals, rationing became a growing concern. Health care providers raise prices to cover the costs of adopting new technologies and upgrading facilities, as well as the rising premiums for malpractice insurance and the potential costs of lawsuits. Hospitals are required to provide emergency care even to uninsured people, and these costs contribute to the overhead costs paid by everyone.

Increased demand is another reason for increased costs. As people become aware of new ways to improve their health, they tend to seek more care. Increased health care screenings can identify conditions earlier, leading to more treatments. People are also living longer, increasing the number of individuals who need care for age-related conditions.

Many of these issues are not inherently problematic, but they do contribute to rising costs. In the United States, this has resulted in increased premiums, copays, and deductibles for people with insurance. Rising costs have also led to lower reimbursement rates for physicians and facilities from government plans such as Medicare and Medicaid, programs that help pay for health care for older adults, individuals with disabilities, individuals experiencing poverty, and others. In countries with government-run health plans, rising costs increase taxes paid by citizens or cause the country to incur greater debt to pay for health care costs.

In the 2010s and 2020s, pharmaceutical companies were criticized for charging US patients excessively high prices for commonly used and often life-saving prescription drugs. One such pharmaceutical is insulin, which is used to treat diabetes. In the United States, over 38 million people have diabetes, and of these, 8.4 million use insulin to manage their condition. Studies of insulin prices in 2018 showed that while it cost between $2 and $4 to make a vial of insulin, the average price of a standard unit of insulin in the US was $99, compared to $8.81 in other high-income nations. Such price gouging, combined with a lack of adequate insurance coverage, led 1.3 million Americans with diabetes to ration their insulin doses in 2021. Some states responded to insulin rationing by capping patient copayments for insulin and other diabetes devices and supplies. On the federal level, President Joe Biden and his administration took steps to address high prescription drug costs through the Inflation Reduction Act of 2022, which allowed Medicare to negotiate directly with pharmaceutical companies starting in 2023 and reduced the amount that Medicare patients paid out of pocket for insulin to $35 per month. In 2023, Eli Lilly and several other manufacturers announced they would match Medicare's cap on insulin costs and set the same price for commercially insured and uninsured patients.

Overview

The idea of rationing often prompts angry reactions from people who envision government bureaucrats denying care to older adults, individuals with disabilities, or other populations. It is often considered in the context of single-payer government-run health plans, such as those in Canada and the United Kingdom, where bureaucrats decide which procedures will be covered and how many people will receive them, leaving some people waiting or going without care. Rationing is often cited as an argument against universal health care, where all citizens of a country have coverage.

However, experts argue that health care is rationed in many ways across nearly every health care system, including a free-market system such as that in the United States. They say insurers that require prior authorization before allowing certain procedures or services are practicing a form of rationing when they only allow those who have met specific requirements to get these services. This is usually done not because the services or procedures have limited availability, but because they are expensive and either diminish profits or use more of the resources available to provide care to others.

Annual or lifetime maximums are another form of rationing; historically, some insurance plans limited the number of visits for mental health, physical therapy, and other services, or placed dollar limits on the amount of durable medical equipment provided. However, in 2010, lifetime and annual limits on essential health benefits were eliminated in the US with the signing of the Affordable Care Act. While they still exist in some narrow contexts, such limits are no longer standard.

The cost of health care produces other forms of rationing, according to some experts. High deductibles, in which individuals must pay a specified amount of their medical expenses before their insurance begins to cover services, can prevent them from obtaining necessary care. High-deductible insurance policies are less expensive, which means those who purchase them may have lower incomes and may have trouble paying for care until the deductible is met. This serves to indirectly ration care.

Some experts contend that there are additional indirect forms of rationing. They claim that government programs that cover people of certain ages or circumstances are rationing care by prioritizing those groups over others. This includes programs such as Medicare, Medicaid, and the Children's Health Insurance Program (CHIP).

Health care rationing is a key aspect in the debate over universal or single-payer government-backed health care and health care policy and reform at large. Those who oppose these programs often assert that they will lead to rationing, in which patients cannot receive the care they and their physicians believe they need. Others argue that this type of rationing is preferable to the indirect rationing already present in free-market systems, in which income serves as a mechanism of rationing by limiting access to health care.


Bibliography

Aaron, Henry J. "Health Care Rationing: What It Means." Brookings Institution, 1 Dec. 2005, www.brookings.edu/research/health-care-rationing-what-it-means. Accessed 26 Dec. 2025.

Berezowski, Jakub, et al. “Rationing in Healthcare: A Scoping Review.” Frontiers in Public Health, vol. 11, 2023, p. 1160691, doi:10.3389/fpubh.2023.1160691. Accessed 26 Dec. 2025.

Frakes, Michael, et al. "The Economics of Healthcare Rationing." Duke Law Scholarship Repository, 29 Aug. 2016, scholarship.law.duke.edu/faculty_scholarship/3652. Accessed 26 Dec. 2025.

Geyman, John. "Does the U.S. Ration Health Care?" Huffington Post, 2 Aug. 2017, www.huffingtonpost.com/john-geyman/does-the-u-s-ration-healt_b_11296230.html. Accessed 26 Dec. 2025.

Geyman, John. "Rationing of Health Care: Private Gain vs. the Common Good." Huffington Post, 15 Dec. 2016, www.huffingtonpost.com/john-geyman/rationing-of-health-care_b_8813426.html. Accessed 26 Dec. 2025.

"Healthcare Rationing." HealthInsurance.org, LLC., www.healthinsurance.org/glossary/healthcare-rationing. Accessed 26 Dec. 2025.

HHS Announces Actions to Lower Health Care Costs and Allow Medicare to Negotiate Lower Drug Prices." US Dept. of Health and Human Services, 30 June 2023, www.hhs.gov/about/news/2023/06/30/hhs-announces-actions-lower-healthcare-costs-allow-medicare-negotiate-lower-drug-prices.html. Accessed 26 Dec. 2025.

Hoffman, Beatrix. "Health Care Rationing Is Nothing New." Scientific American, 18 Jan. 2013, www.scientificamerican.com/article/health-care-rationing-is. Accessed 26 Dec. 2025.

Luhby, Tami. "More Americans Now Get Insulin for $35." CNN, 2 Jan. 2024, www.cnn.com/2024/01/01/politics/insulin-price-cap/index.html. Accessed 26 Dec. 2025.

Malcolm, Candice. "The Pitfalls of Single-Payer Health Care: Canada's Cautionary Tale." National Review, 13 Apr. 2017, www.nationalreview.com/article/446689/canada-single-payer-health-care-system-failures-cautionary-tale. Accessed 26 Dec. 2025.

Mole, Beth. "Eli Lilly Cuts Insulin Prices after Years of Outrage." Ars Technica, 1 Mar. 2023, arstechnica.com/science/2023/03/eli-lilly-to-match-medicares-35-insulin-cost-cap-after-furor. Accessed 26 Dec. 2025.

Moosa, Mohammed R., and Valerie A. Luyckx. “The Realities of Rationing in Health Care.” Nature Reviews Nephrology, vol. 17, no. 7, 2021, pp. 435–36, doi:10.1038/s41581-021-00404-8. Accessed 26 Dec. 2025.

Pearl, Robert. "Why Healthcare Rationing Is a Growing Reality for Americans." Forbes, 2 Feb. 2017, www.forbes.com/sites/robertpearl/2017/02/02/why-healthcare-rationing-is-a-growing-reality-for-americans. Accessed 26 Dec. 2025.

Porter, Eduardo. "Rationing Health Care More Fairly." New York Times, 21 Aug. 2012, www.nytimes.com/2012/08/22/business/economy/rationing-health-care-more-fairly.html. Accessed 26 Dec. 2025.

Searing, Linda. "Over 1 Million Americans with Diabetes Rationed Insulin in Past Year." The Washington Post, 8 Nov. 2022, www.washingtonpost.com/wellness/2022/11/08/diabetes-insulin-rationing. Accessed 26 Dec. 2025.

Full Article

Health care rationing is the practice of restricting the amount or level of medical care available to a person or group of people. It is most often thought of in terms of government-run programs that refuse to allow certain procedures or treatments for some or all of the people they cover. However, experts argue that health care rationing occurs in many forms and in nearly every health care system, including a free market system like the one in the United States.

Background

Rationing is a practice that calculates how far an available service or item will go and makes rules about how to distribute it. It is typically implemented when demand exceeds supply. For example, during World War II (1939–1945), food items such as sugar, meat, and butter were rationed, as was gasoline. These items were needed to provide for American soldiers and those directly affected by the war overseas, so the government limited how much people in America could purchase to make sure everyone got something, and no one had significantly more than anyone else did.

There can also be more need for health care than there are available services or supplies. This is often the case in underdeveloped countries, where people may live in remote areas with few or no advanced medical services available. In these areas, people may die or suffer unnecessarily because doctors and hospitals are not available. Yet, this is not considered rationing because the care is not available at all, and it is not being restricted intentionally.

Health care rationing usually refers to situations in which health care is available but is limited for some reason; the care is usually available, but the funds to pay for it are not. This leads to restrictions on who can get care, when they can get it, or what care is accessible based on the amount of money available to pay for it. Care can also be restricted so that the available pool of money can be directed toward services thought to provide greater benefits or a higher chance of success.

As health care costs increased due to emerging technologies, advanced procedures, and pharmaceuticals, rationing became a growing concern. Health care providers raise prices to cover the costs of adopting new technologies and upgrading facilities, as well as the rising premiums for malpractice insurance and the potential costs of lawsuits. Hospitals are required to provide emergency care even to uninsured people, and these costs contribute to the overhead costs paid by everyone.

Increased demand is another reason for increased costs. As people become aware of new ways to improve their health, they tend to seek more care. Increased health care screenings can identify conditions earlier, leading to more treatments. People are also living longer, increasing the number of individuals who need care for age-related conditions.

Many of these issues are not inherently problematic, but they do contribute to rising costs. In the United States, this has resulted in increased premiums, copays, and deductibles for people with insurance. Rising costs have also led to lower reimbursement rates for physicians and facilities from government plans such as Medicare and Medicaid, programs that help pay for health care for older adults, individuals with disabilities, individuals experiencing poverty, and others. In countries with government-run health plans, rising costs increase taxes paid by citizens or cause the country to incur greater debt to pay for health care costs.

In the 2010s and 2020s, pharmaceutical companies were criticized for charging US patients excessively high prices for commonly used and often life-saving prescription drugs. One such pharmaceutical is insulin, which is used to treat diabetes. In the United States, over 38 million people have diabetes, and of these, 8.4 million use insulin to manage their condition. Studies of insulin prices in 2018 showed that while it cost between $2 and $4 to make a vial of insulin, the average price of a standard unit of insulin in the US was $99, compared to $8.81 in other high-income nations. Such price gouging, combined with a lack of adequate insurance coverage, led 1.3 million Americans with diabetes to ration their insulin doses in 2021. Some states responded to insulin rationing by capping patient copayments for insulin and other diabetes devices and supplies. On the federal level, President Joe Biden and his administration took steps to address high prescription drug costs through the Inflation Reduction Act of 2022, which allowed Medicare to negotiate directly with pharmaceutical companies starting in 2023 and reduced the amount that Medicare patients paid out of pocket for insulin to $35 per month. In 2023, Eli Lilly and several other manufacturers announced they would match Medicare's cap on insulin costs and set the same price for commercially insured and uninsured patients.

Overview

The idea of rationing often prompts angry reactions from people who envision government bureaucrats denying care to older adults, individuals with disabilities, or other populations. It is often considered in the context of single-payer government-run health plans, such as those in Canada and the United Kingdom, where bureaucrats decide which procedures will be covered and how many people will receive them, leaving some people waiting or going without care. Rationing is often cited as an argument against universal health care, where all citizens of a country have coverage.

However, experts argue that health care is rationed in many ways across nearly every health care system, including a free-market system such as that in the United States. They say insurers that require prior authorization before allowing certain procedures or services are practicing a form of rationing when they only allow those who have met specific requirements to get these services. This is usually done not because the services or procedures have limited availability, but because they are expensive and either diminish profits or use more of the resources available to provide care to others.

Annual or lifetime maximums are another form of rationing; historically, some insurance plans limited the number of visits for mental health, physical therapy, and other services, or placed dollar limits on the amount of durable medical equipment provided. However, in 2010, lifetime and annual limits on essential health benefits were eliminated in the US with the signing of the Affordable Care Act. While they still exist in some narrow contexts, such limits are no longer standard.

The cost of health care produces other forms of rationing, according to some experts. High deductibles, in which individuals must pay a specified amount of their medical expenses before their insurance begins to cover services, can prevent them from obtaining necessary care. High-deductible insurance policies are less expensive, which means those who purchase them may have lower incomes and may have trouble paying for care until the deductible is met. This serves to indirectly ration care.

Some experts contend that there are additional indirect forms of rationing. They claim that government programs that cover people of certain ages or circumstances are rationing care by prioritizing those groups over others. This includes programs such as Medicare, Medicaid, and the Children's Health Insurance Program (CHIP).

Health care rationing is a key aspect in the debate over universal or single-payer government-backed health care and health care policy and reform at large. Those who oppose these programs often assert that they will lead to rationing, in which patients cannot receive the care they and their physicians believe they need. Others argue that this type of rationing is preferable to the indirect rationing already present in free-market systems, in which income serves as a mechanism of rationing by limiting access to health care.


Bibliography

Aaron, Henry J. "Health Care Rationing: What It Means." Brookings Institution, 1 Dec. 2005, www.brookings.edu/research/health-care-rationing-what-it-means. Accessed 26 Dec. 2025.

Berezowski, Jakub, et al. “Rationing in Healthcare: A Scoping Review.” Frontiers in Public Health, vol. 11, 2023, p. 1160691, doi:10.3389/fpubh.2023.1160691. Accessed 26 Dec. 2025.

Frakes, Michael, et al. "The Economics of Healthcare Rationing." Duke Law Scholarship Repository, 29 Aug. 2016, scholarship.law.duke.edu/faculty_scholarship/3652. Accessed 26 Dec. 2025.

Geyman, John. "Does the U.S. Ration Health Care?" Huffington Post, 2 Aug. 2017, www.huffingtonpost.com/john-geyman/does-the-u-s-ration-healt_b_11296230.html. Accessed 26 Dec. 2025.

Geyman, John. "Rationing of Health Care: Private Gain vs. the Common Good." Huffington Post, 15 Dec. 2016, www.huffingtonpost.com/john-geyman/rationing-of-health-care_b_8813426.html. Accessed 26 Dec. 2025.

"Healthcare Rationing." HealthInsurance.org, LLC., www.healthinsurance.org/glossary/healthcare-rationing. Accessed 26 Dec. 2025.

HHS Announces Actions to Lower Health Care Costs and Allow Medicare to Negotiate Lower Drug Prices." US Dept. of Health and Human Services, 30 June 2023, www.hhs.gov/about/news/2023/06/30/hhs-announces-actions-lower-healthcare-costs-allow-medicare-negotiate-lower-drug-prices.html. Accessed 26 Dec. 2025.

Hoffman, Beatrix. "Health Care Rationing Is Nothing New." Scientific American, 18 Jan. 2013, www.scientificamerican.com/article/health-care-rationing-is. Accessed 26 Dec. 2025.

Luhby, Tami. "More Americans Now Get Insulin for $35." CNN, 2 Jan. 2024, www.cnn.com/2024/01/01/politics/insulin-price-cap/index.html. Accessed 26 Dec. 2025.

Malcolm, Candice. "The Pitfalls of Single-Payer Health Care: Canada's Cautionary Tale." National Review, 13 Apr. 2017, www.nationalreview.com/article/446689/canada-single-payer-health-care-system-failures-cautionary-tale. Accessed 26 Dec. 2025.

Mole, Beth. "Eli Lilly Cuts Insulin Prices after Years of Outrage." Ars Technica, 1 Mar. 2023, arstechnica.com/science/2023/03/eli-lilly-to-match-medicares-35-insulin-cost-cap-after-furor. Accessed 26 Dec. 2025.

Moosa, Mohammed R., and Valerie A. Luyckx. “The Realities of Rationing in Health Care.” Nature Reviews Nephrology, vol. 17, no. 7, 2021, pp. 435–36, doi:10.1038/s41581-021-00404-8. Accessed 26 Dec. 2025.

Pearl, Robert. "Why Healthcare Rationing Is a Growing Reality for Americans." Forbes, 2 Feb. 2017, www.forbes.com/sites/robertpearl/2017/02/02/why-healthcare-rationing-is-a-growing-reality-for-americans. Accessed 26 Dec. 2025.

Porter, Eduardo. "Rationing Health Care More Fairly." New York Times, 21 Aug. 2012, www.nytimes.com/2012/08/22/business/economy/rationing-health-care-more-fairly.html. Accessed 26 Dec. 2025.

Searing, Linda. "Over 1 Million Americans with Diabetes Rationed Insulin in Past Year." The Washington Post, 8 Nov. 2022, www.washingtonpost.com/wellness/2022/11/08/diabetes-insulin-rationing. Accessed 26 Dec. 2025.

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