Health care rationing: its effects on cardiologists in the United States and Britain

Cardiologists practicing under contrasting types of health care rationing in the United States and Britain were found to differ significantly in the occupational stresses they experience, according to this exploratory study. In-depth interviews revealed that the 24 American physicians complained most about increasing limits to their autonomy resulting from the intrusion of government, insurance companies and managed care agencies. Twenty-one British cardiologists indicated greater concern about workloads and the lack of resources in the National Health Service. The stresses are associated with the different types of health care rationing in the two countries. In the United States, where explicit rationing exists, external controls are placed on length of hospital stays, tests and procedures, physicians' fees and the use of drugs. In Britain, implicit rationing is imposed by limiting overall funding of health care, leaving physicians free to make clinical decisions. However, the ethic of care for all and the limited funding create waiting lists and a lack of facilities.