Rule of Rescue


Health Economics

  • This so-called 'rule' is often proposed as an alternative (or supplement) to a cost-effectiveness criterion for selecting which treatments ought to be made available and to whom. The rule of rescue reflects, in a general sense, a concern that many people have for those facing the immediate prospect of death (or something else regarded as pretty awful) and, in economic terms, it might be seen as a way of describing a caring externality. In situations where cost-effectiveness is being used as the basic criterion for determining the treatments that are to be made available within a health care benefits package, the rule of rescue is suggested as an element to be brought into consideration when the incremental cost-effectiveness ratio is highly unfavourable, there is only one treatment option, death is imminent, the situation occurs rarely and the total cost to the third party payer is 'small' (these are criteria used by the Australian Pharmaceutical Benefits Scheme). It is not altogether clear whether ethical awkwardnesses in the application of cost-effectiveness principles might be better avoided in other ways. The intentions of those advocating the 'rule' might still be realized by weighting health gains for those with relatively short life expectancy, or with chronic past and/or prospective disabilities, higher than health gains accruing to others, without needing to supplement the cost-effectiveness algorithm. It seems plain however, whatever one may think of its merits, that it is not really a 'rule' at all.