Judges’ comments:
The terrific series addressed one of the hottest 2010 election topics in a different and fascinating way by looking at the realities faced in other parts of the world.
I was hooked by the first characters – doctors deciding who will get life-saving dialysis in South Africa.
It was clever to not start with the obvious – the much demonized British system – but smart not to wait beyond part 2 to address this country as well. Parts 3 & 4 were also very intriguing and the analysis in the final part was a nice way to button up the series without belaboring the points already made in the previous episodes. Great job.
1. Provide the title of your story or series and the names of the journalists involved.
Rationing Care: Who Lives? Who Decides?
David Baron, Sheri Fink, Patrick Cox
Listen to this entry:
Part 1 | Part 2 | Part 3 | Part 4 | Part 5
2. List date(s) this work was published or aired.
December 14-17, 2010
3. Provide a brief synopsis of the story or stories, including any significant findings.
In 2010 PRI’s The World reported from South Africa, Great Britain, Zambia and India to examine how other governments manage the costs of delivering health services to the public. Each country, with its unique economic and cultural environment, provided an opportunity to spotlight different approaches to the challenge of rationing scarce health care resources: explicit rationing by committee, rationing by cost effectiveness, unintentional rationing, and innovation to avoid rationing altogether. Sheri Fink reported on committee-directed rationing of kidney dialysis in South Africa. Patrick Cox examined rationing-by-cost effectiveness in Britain’s National Health Service. Series editor David Baron studied Zambia’s overburdened HIV clinics. Some doctors there believe a quiet “rationing by queue” — allowing lines to determine who lives and who dies — is occurring. Sheri Fink rounded out the series in India, where an innovative pediatrician found ways to minimize or avoid rationing. At the conclusion of the series, anchor Lisa Mullins spoke with Dan Wikler, an ethics professor at the Harvard School of Public Health, about the relevance of the stories to the debate over healthcare reform and explicit and implicit forms of rationing in the United States. The series, the result of a more than half-year reporting and editing effort, was presented along with a multi-media website (www.rationinghealth.org) and opportunities for interaction via Twitter and online discussions with the reporters and with Wikler. We believe the series, which provided American listeners with real-world examples of how other nations handle — or mishandle — the challenges of distributing scarce health care resources, will continue to inform the ongoing health care debate in the United States, underscoring the value of international reporting in the American media.
4. Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
For the South Africa story, we obtained unpublished copies of newly developed dialysis rationing guidelines and compared them with the (also unpublished) checklists actually used by dialysis selection committees. Many of the stories involved months of preparatory research reviewing medical journal articles. The UK story involved online research in NICE databases.
5. Explain types of human sources used.
Human sources included physicians, health economists, ethicists, patients, patient advocacy organizations (e.g. cancer patient groups in the UK), and government officials in all four countries. Many more sources were interviewed than appeared in the stories, providing background and expertise to ground our reporting.
6. Results (if any).
The series received an enthusiastic and engaged response from listeners. Many participated in online, in depth discussions and debate about healthcare rationing with the reporters and with Harvard School of Public Health professor Dan Wikler. The series also interested other media, and portions of the series were excerpted on the BBC News website, ProPublica.org, the Huffington Post, and the Cape Times newspaper in South Africa, where the public had been largely unaware of the existence of dialysis selection committees. The series also sparked follow on media coverage, including in the Cape Times, which published additional stories on dialysis rationing and numerous opinion pieces and letters to the editor. For example, a dialysis nurse and former president of the renal society of South Africa, who had previously served on one of the selection committees, contributed a passionate op-ed : “According to [Fink’s report], there was a public outcry in 1962 in the US when the selection process was exposed in Life magazine,” she wrote. “Why, 48 years on, do we in South Africa just sit back and allow this to continue? Why this apathy when life and death decisions are made by a group of strangers who often have limited information about the value of this person’s life?” The series also resonated within healthcare policy circles in Washington D.C. For example, Fink was invited to discuss the series as a “respondent” to officials from NICE (the body that makes rationing recommendations in the UK) at an event on healthcare rationing organized by the Center for Global Development.
7. Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
No
8. Advice to other journalists planning a similar story or project.
Working as a team on a complex subject like this was extremely helpful. We each brought very different backgrounds to the mix and we all helped edit each other’s stories and shape each piece. Teaming up with people whose skill sets don’t overlap with yours is a great way to grow as a reporter. For those who don’t typically cover medical topics, pairing up with at least one person who works in the field and understands the implications of your findings will help you take your story deeper. For those who do typically cover medical topics, pairing up with those who don’t can help ensure that a story makes sense and hits the right notes for a general audience.