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As a result of the aging of American society, health care costs have been and will continue to rise, to the extent that they are not sustainable. Obviously, this trend will continue in spite of the 2010 health care reform. As a result of this uncontrollable problem, writers such as Daniel Callahan have proposed age‐based rationing of health care while utilizing the utilitarian notions of ethics and justice. However, other writers, utilizing more egalitarian notions of justice, have opposed this. This suggests an ethical dilemma, which has to be debated in the future. The author believes professors teaching health care related courses will be instrumental in this debate, explaining why she decided to seek the opinion of a sample of 18 professors regarding this issue. The purpose of this paper is to report on the results of this research.

Qualitative methodology, specially grounded theory, was used in this study that sought to explore the views of 18 full‐time professors who teach health care policy and administration in Northeast Pennsylvania about age‐based rationing of health care. Qualitative research is very useful uncovering the views of individuals as they relate to their experiences. In the study, professors were asked 14 questions by the author, four of these being demographic. The remaining ten questions, open ended ones, sought the opinions of these professors about their support or opposition to age‐based rationing.

The author's interviews of those 18 professors and the analysis of the responses, which revealed the complexity and multidimensional nature of the issue, led to the emergence of eight different themes.

The author used a qualitative method of research, interviewing 18 professors, to uncover personal views not previously published.

Notes the problem of rising health care costs in the USA. Considers a highly controversial solution to this problem, which is to consider health care as a scarce resource and to ration access to it. Whether rationing is done by age, ability to pay, or a cost‐benefit analysis, the very concept contradicts the US belief in the right to health care. Other industrialized countries currently ration health care through a National Health Insurance Plan. Points out that, in the USA, individual states are beginning to consider health care rationing to combat shrinking budgets and increasing demand for services.

The United States’ population is rapidly aging. As older people require more expensive medical and nursing attention, health-care/nursing costs keep rising, to the extent that they are not sustainable. As a result, the USA is faced with an ethical dilemma. While egalitarian ethical principles and the provisions of the American Nurses Association (ANA) code of ethics require the provision of medical/nursing care to everyone regardless of age, severity of disease and productivity, utilitarians view that as impossible. Assuming that provisions ANA’s codes of ethics are the same as ethical principles, this paper aims to discuss the debate between those two sides in detail.

The paper, viewing the rise of health-care/nursing costs as the cause of the above ethical dilemma, discusses Daniel Callahan’s utilitarian argument that, given the ever-rising health/nursing costs as a percentage of GDP, the USA will be forced to ration health care/nursing on the basis of age. The ethical arguments opposing Callahan’s arguments will also be presented.

While the debate between those two viewpoints is bond to continue, some writers have tried to find a compromise, a solution by assuming that, through efficiency, health/nursing costs can be lowered, making Callahan’s age-based rationing unnecessary.

This paper is original as it, by including nursing costs as an inseparable component of health-care costs, makes the aforementioned debate applicable to nursing care.

The allocation of resources is a complex problem in health care. In Finland there has been an effort to solve the problems with a program called “Securing the Future of Health Care”. The main focus of this research is on assessing how managers view the health care policy called guarantee of care from an ethical perspective.

The theoretical basis of the research covers theories regarding rationing, prioritization, as well as the ethics of health care. The empirical data were gathered through an internet questionnaire. The questionnaires were sent to the top managers in all Finnish health care districts (20 in all). The data were analyzed qualitatively.

According to respondents, ensuring access to treatment partially fulfilled the ethical principles of the right to good care, respect for human dignity, fairness, and co‐operation and mutual respect quite well. On the other hand, trust, impressiveness, non‐partiality in decision making and the right of self‐determination were not as well realized. The shortening of waiting lists had caused exhaustion and motivation problems among personnel and in addition, staff shortages were being experienced.

The administrators of the hospital districts agreed that centralizing resources as a reconstructive action is ethically wrong for the whole health care system. There is a great need for an ethical discussion concerning the choices made in health care policy. Long‐term results need sustainable solutions.

The purpose of this paper is to explore Croatian views about issues regarding bedside rationing decisions.

An online questionnaire was used to collect data from a sample of 243 Croatian citizens. In a context of hypothetical scenarios involving priority setting decisions taking by physicians, the present study elicits Croatian respondents’ views concerning: the ethical principles that should guide patients prioritization; the parties that should make prioritization decisions; and the likelihood of healthcare rationing becoming a reality. Descriptive analysis, factor analysis and parametric and non-parametric tests were performed.

Findings suggest that Croatian respondents: support multiple substantive rationing criteria, with an incident in favoring the worst-off, reducing inequalities in health, translated in the fair-innings argument and efficiency achievement; appoint health professionals as rationing decision makers; and do not seem to believe in the possibility of patient selection becoming a reality.

Favoring the worst-off, equalizing life time health and the pursuit of efficiency seem to be the criteria most preferred by Croatian respondents to guide rationing policy at the micro level.

This study is the first attempt to elicit Croatian opinions concerning several rationing criteria inherent in healthcare micro allocation decisions. Healthcare rationing is a serious challenge to Croatian policy makers and so it would be useful for the public’s perceptions and beliefs to be considered.

The purpose of this paper is to start a debate about older people who are in groups that are not readily visible to policy makers and practitioners.

The paper is based on information obtained from academic literature, government statistics and other publications from relevant organisations. The authors investigated one “invisible” group each and comparisons and conclusions were then made collaboratively.

Many groups of older people seem to be absent from statistics and from policy making. The paper suggests that there needs to be more research to identify the scale of any problems and how they may be solved.

This is not a systematic review but a preliminary account of the problem.

There are practical implications for health and social care professionals if they do not recognise that there are groups in society about whom little is known. Lack of knowledge and empathy may affect their approach to these groups.

There are implications for society if these groups are not taken into account in decision making and especially over the allocation of resources.

There is little written which brings together the lack of attention paid to these groups as a whole.

The purpose of this paper is to uncover attitudes of physical therapists (PTs) who treat vegetative state (VS) patients, and to raise awareness to ethical and professional dilemmas: Are PTs influenced by ageist perceptions? Do they consider physiotherapy to be effective or futile?

Ethical questions and complex dilemmas are by and large subconscious and rarely explicitly voiced, but can be identified by revealing implicit therapists' personal and professional approach to patients. A quantitative six‐point Likert scale questionnaire was developed, which presented two VS cases – young and old, followed by practical‐ethical questions concerning key issues including: treatment choices, quality of life, prolongation of life, futile treatment (n=101, 68 percent return rate).

The results reveal a complex reality: on the one hand PTs expressed a positive perception of their profession, and consider all treatment components important for VS patients and their families regardless of age; on the other hand, significant preference for treating the younger VS patient was found.

There is a need for raising awareness of physiotherapists to the social phenomenon of ageism and its implications on daily professional and ethical conduct.

While other studies revealed ageism in various health care settings, this study was original both in its methodology (examining implicit ageism via contrasting vignettes), and its unique context (VS patients) which in theory could be viewed as “ageless” in light of the patients' permanent condition.

This paper aims to present a case study where proportional hazards modeling software is used to evaluate the potential benefits of a condition‐based maintenance policy for military vehicle diesel engines.

Maintenance records for diesel engines were supplied by the UK Ministry of Defence. A proportional hazards model based on these data was created using EXAKT software. Covariate parameters were estimated using the maximum likelihood method and transition probabilities were established using a Markov Chain model. Finally, decision parameters were entered to create an optimal decision model.

Two significant covariates were identified as influencing the hazard rate of the engines. In addition, the optimal decision model indicated a potential economic saving of up to 30 per cent.

A model of this nature is particularly useful to predict failures, improve maintenance policies, and possibly reduce maintenance costs. In addition, the cost of implementing maintenance policies based on this model should be balanced with the potential to reduce the risk of danger to personnel.

The model presented provides military personnel with a decision tool that optimizes the maintenance policy for diesel engines installed in military vehicles.

The purpose of this paper is to investigate how firms in developing countries finance innovation. Notably, the study seeks to investigate whether innovative firms exhibit financing patterns different from those of non-innovative ones. It also examines the effect of financing sources on firm’s probability to innovate.

The study utilizes firm-level data from the World Bank Enterprise Survey. From 28 African countries, 11,173 firms have been included in the sample. A statistical t-test is used for two independent samples and logistic regression models.

The results show that innovative firms, specifically innovative small- and medium-size firms exhibit financing patterns different from non-innovative peers. Further analysis indicates that there is no statistically significant difference between the financing patterns of innovative and non-innovative large firms. In Africa, innovation is mostly financed using internal sources and bank finance. Equity finance and bank finance have shown a higher effect followed by internal finance, finance from non-bank financial institutions and trade credit finance on firms’ probability to innovate.

The management of innovative firms should reduce dependency on short-term and retained earning financing and increase the use of long-term instruments improve innovation performance.

A pending policy task for African leaders is to design and evaluate reforms to create a strong financial sector that willing to support the innovation process.

This study contributes to the existent literature on finance of innovation by examining how firms finance innovation activities in developing countries. This study provides evidence on how innovative firms exhibit financing patterns different from non-innovative ones from developing countries.