Everyday experiences of implicit rationing: comparing the voices of nurses in California and British Columbia

Managed Care in the U.S. is one of the more controversial strategies to implicitly ration health care. It has also been creeping into Canada where care is similarly being managed albeit in a different socio-political environment. Based on nine group interviews with 35 RNs in California and 10 group interviews with 39 RNs in British Columbia, we find that the price to be paid for the promise of cheaper, more efficient health care through managerial strategies is borne largely by nurses and other health care providers. The data reveal that nurses in British Columbia and California share similar experiences with how the amount of care is rationed at the bedside - through care pathways, early discharge policies and reduced staffing - while the rationing of access to care differs because of the sociopolitical contexts of their respective health care systems. In both cases, the implicit rationing of care through managerial strategies fails to deliver on its promises.