13 - Allocating Health Care Resources Flashcards
Why do we need rationing?
No healthcare system has unlimited resources
Demand always exceeds supply
Increased efficiency and more funding are temporary solutions at best
What is the difference between explicit and implicit rationing of healthcare?
Explicit: Charge user fees to reduce unecessary use
Implicit: Long wait times also discourages unecessary use
In what ways can rationing occur in the healthcare system?
Between healthcare and other uses: health vs. education
Between different health outcomes: physical vs. mental health
Between different types of treatment: surgery vs. drugs vs. behaviour
Between different patient groups: very young vs. very old
What is tragic choice?
The choice is between options with only marginal differences, but the potential outcomes for both are equally unpalatable.
How do we decide?
What does the phrase, “If all cannot have it, none can have it” mean and what are its consequences?
In this situation, we are not willing to pick one group over another. This means both sides are harmed.
Resources may be left unused/wasted when benefit for some was possible.
This is not a good resource allocation option. We must make a choice to use resources effectively
What does the phrase, “To each, an equal share…” mean and what are its consequences?
Everyone recieves equal treatment irrespective of need.
ex. Health Spending Accounts
The amount recieved often insufficient for many while others will not use all they recieve. This results in loss of resources, or used frivolously. Little consideration of the disproportional nature of need
What does the phrase, “First come, first served…” mean and what are its consequences?
Line up and those who are at the start if the line are helped first
Tends to favour experienced, affluent and/or well-connected groups and individuals.
Potential delays for those with more urgent need. (happened with COVID-19 vaccine distribution)
What does the phrase, “To each according to merit (contribution to society)…” mean and what are its consequences?
Those whose contributions to society are valued the most are given priority for healthcare.
People who are unemployed
Negative consequences of people’s actions are seen to be less worthy of care.
What does the phrase, “To each according to ability to pay…” mean and what are its consequences?
Let the market decide the “true” value of a good/service and allow those willing to pay the value to recieve the good/service
Those without capacity have little or no access
Those with need can be priced out of market
What does the phrase, “To each according to need…” mean and what are its consequences?
Usually those most socially and economically disadvantaged, with likelihood of improving health status are helped in this model (Equity vs.Equality)
Consequence: Equitable care results in some inefficiencies in regards to the amount of money spend vs. return in benefit
What does the phrase, “Greatest good for the greatest number…” mean and what are its consequences?
Based on maximizeing social benefit (utilitarian). Resources are allocated to groups or individuals seen to provide the greatest benefit for the resources available
Fails to consider egalitarian concerns or a general wish to prioritize the worst off when deciding how to allocate resources
What is the Rule of Rescue (ROR)?
There is a fact about the human psyche that will inevitably trump the utilitarian rationality that is implicit in cost-effectiveness analysis: people cannot stand idly by when an identified person’s life is visibly threatened if effectove resue measures are available. The concern with this approach is potential to over-extend resources
Is the Rule of Rescue fair?
It tilts towars those who we identify with, see as more worthy, or who are able to create more awareness of, or sympathy for, in others
The unknown, or unsympathetic are disadvantged, and less likely to recieve assistance; even if the need is greater
How is the “Fair innings” concept relevant to resource allocation?
We all get a chance at life, we give priority to the young, as well as those who have not enjoyed a high quality are given priority in resource allocation
What is pluralistic bargaining?
A process by which multiple groups seek to influence policies and practices, and each other.
Recognizes the various analytical tools and ethical principles available to those seeking to allocate scarce resources
Advocates for the necessity of continuous and collective argument
