Healthcare Reform, Rationing,

Healthcare reform and rationing have become almost household words in many Western countries, including Israel. The public, health professionals, and political leaders are united in the belief that a serious problem exists in providing comprehensive healthcare to the entire population at an affordable and politically acceptable price. It is important to preserve our sense of proportion. Most of the literature on healthcare rationing comes from countries representing a relatively small percentage of the world’s population – basically, the wealthier countries. According to World Bank figures, the world’s total health expenditure for 1990 was $1.7 trillion, or eight percent of the world’s product. High-income countries spent ninety percent of this amount, with the United States alone consuming forty-one percent of the global total. The average annual expenditure in high-income countries was $1,500 per person. Developing countries spent approximately ten percent of the global total, an annual average of $41 per person – four percent of their gross national product and one-thirtieth of the amount spent by the wealthy countries. Let us not forget that healthcare inequities are mostly intranational. In the worst of the developed countries these do not even approach the magnitude of the catastrophic differences between the developed and the developing countries. These gaps are so great and so seemingly unbridgeable that we generally avoid the topic, but the point should be made, if only to pay lip service to our consciences.