Rationing. Constructed Realities and Professional Practices. Sociology of Health and Illness Monographs

  • ID: 2247957
  • Book
  • 216 Pages
  • John Wiley and Sons Ltd
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This volume examines health care rationing in action using recent case studies from the United Kingdom, Europe and North America. Drawing on data from a variety of hospital and community settings, the contributors show how prioritisation and access to care depend on organisational arrangements and professional practices, which are often invisible to the service user.

Unusually for a book on this topic, many of the chapters provide detailed accounts of micro–level decision making at the point of service delivery. They seek to penetrate the ′black box′ of the organisation – the emergency department, the intensive care unit, the cancer genetics clinic or the community mental health team – to shed light on processes by which access to care is denied, delayed, or otherwise limited. The book presents a picture of rationing processes that are ′implicit′ rather than ′explicit′, and closely woven into the fabric of professional cultures and modes of working.

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Notes on Contributors.

1. Introduction. A sociological perspective on rationing: power, rhetoric and situated practices (Donald Light and David Hughes).

2. Risk and Rationing. Rationing through risk assessment in clinical genetics: all categories have wheels (Lindsay Prior).

3. Governmentality and risk: setting priorities in the new NHS (Paul Joyce).

4. Rationing in Hospitals. Categorisation and micro–rationing: access to care in a French emergency department (Carine Vassy).

5. Everyday experiences of implicit rationing: comparing the voices of nurses in California and British Columbia (Ivy Lynn Bourgeault, Pat Armstrong, Hugh Armstrong, Jacqueline Choiniere, Joel Lexchin, Eric Mykhalovskiy, Suzanne Peters and Jerry White).

6. Rationing in the Community. Rationing health car to disabled people (Gary L. Albrecht).

7. Categorising to exclude: the discursive construction of cases in community mental health teams (Lesley Griffiths).

8. Professional Resistance. Subverting criteria: the role of precedent in decisions to finance surgery (John Heritage, Elizabeth Boyd and Lawrence Kleinman).

9. Clinical actions and financial constraints: the limits to rationing intensive care (Irvine Lapsley and Kath Melia).


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David Hughes
Donald Light
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