POLICY AND SUPPORTING THEORY Flashcards
What are Bradshaw’s types of need?
Felt- percieved by individual due to e.g. ill health
Expressed- as acted on by individual by e.g. demand for healthcare
Normative- professional judgement of need
Comparative need- based on needs of people with similar attributes
What is a consequentialist approach to justice?
Justice of system determined by outcomes
What is utilitarianism?
A key thinker: bentham
Society should maximise utility: greatest good for greatest number
Example of consequentialist approach
+ all people treated equally
- Can benefit majority at expense of minority
-Can increase inequity
- How do we define utility?
- What consequences do we choose?
What is Pareto efficiency?
also referred to as allocative efficiency, occurs when resources are so allocated that it is not possible to make anyone better off without making someone else worse off.
○ Critique: can end up as an argument against taking action which then maintains inequity?
What is the deontological approach to justice?
Key thinker: Kant
Justice is determined by rules arrived at by logical reasoning, not consequences
Key concept is the categorical imperative: commands or moral laws all persons must follow, regardless of their desires or extenuating circumstances.
Underpins human rights
+ Avoids issues with unintended consequences
- Assumes people will follow rules rather than their own wants
- Mill argues you still need to consider consequences to pick the rules
-Doesn’t explain what to do if rules conflict one another
What is Rawls’ approach to justice?
Justice as fairness.
Determined by set of rules arrived at from position of veil of ignorance- if you didnt know where in society you sat, how would you want the rules?
Inequalities in outcomes only permissable if:
equality of oppurtunity
Inequality favours welfare of worst off
Critique:
Primacy of liberty
Can’t truly have veil of ignorance
Implementation depends on empirical facts
People may not agree on rules
Assumes rules will be followed
Can’t have equality of oppurtunity
What is procedural justice?
What are Leventhal et al’s six criteria for a fair process?
Use of a fair process to resolve disputes or allocate resources. Underpins NICE’s model for rationing
Leventhal et al 6 criteria for a fair process:
- Consistency
- Neutrality (unbiased)
- Based on accurate info
- Correctible
-Open to all (voice)
- Ethical
Give examples of rationing at national, local and individual levels
National- NICE decisions around funding of treatments
Local- local authority funding of services
Individual- clinician decisions around individual treatments,
What is the four principles framework? (Beauchamp and Childress)
Beneficence- doing good
Non-maleficence- avoiding doing harm
Autonomy- enabling individuals to make an informed choice
Justice- fairness of health and care distribution
What are Daniels and Sabin’s four principles of “accountability for reasonableness” 1997
Transparency
Public visibility of ethnical framework/principles/rationale behind priorities.
Relevancy
Priorities should be set based on evidence, reasons and principles that fair-minded parties (including patients and clinicians) agree are relevant under the circumstances.
Appeal
Opportunity to review decisions in light of new evidence/circumstances. Mechanism for challenge and dispute.
Enforcement
Appropriate governance and accountability structures to ensure the above conditions are met.
Describe the case for use of implicit rationing
(Coast, 1997):
-Practicality: explicit rationing is impractical because there are no clear criteria on which to base rationing.
-The utility of ignorance: there are emotional consequences of explicit rationing.
-Denial disutility: in explicit rationing, citizens that become involved in the process of denying care to particular groups or individuals may experience disutility (unhappiness/guilt/anxiety/disgust).
-Deprivation disutility: in explicit rationing, particular individuals may experience disutility when they are informed that their care is being rationed.
-Bureaucratic and political effectiveness: the administrative and bureaucratic processes of healthcare provision will run more smoothly in implicit rationing systems.
Describe the case for explicit rationing
(Doyal, 1997):
-While there are no clear criteria on which to base explicit rationing, policy makers can, however, report the ethical principles on which rationing decisions are generally made.
-Implicit rationing will undermine citizens’ moral commitments to democracy.
-Any benefit derived from deception (avoiding denial disutility and deprivation disutility) will be sustained only while people are kept in ignorance.
-If citizens are not informed of the principles guiding rationing, then rationing may be guided by only a few voices.
-Informed democratic feedback can improve effectiveness of health care.
What is an Individual Funding Request?
This is National Health Service (NHS) funding for drugs, operations or other care that is not routinely funded by the NHS. Normally this is because they:
are clinically not effective or effectiveness has yet to be determined
are not cost effective in comparison to all the competing demands on NHS funding
have a low clinical priority and offer little health gain
are largely cosmetic in nature.
Clinicians can make an individual funding request for a treatment if
it is a very new treatment or drug and has no commissioning policy available
there are exceptional reasons why the treatment or drug should be available to an individual patient.
A treatment may be funded on an individual basis if
The patient has a set of circumstances that are very different from anyone else meaning they will derive greater benefits from the intervention than others who are in a similar position
AND
There is good evidence to suggest that they would be healthier after the treatment or operation.
What is an Individual Funding Request?
This is National Health Service (NHS) funding for drugs, operations or other care that is not routinely funded by the NHS. Normally this is because they:
are clinically not effective or effectiveness has yet to be determined
are not cost effective in comparison to all the competing demands on NHS funding
have a low clinical priority and offer little health gain
are largely cosmetic in nature.
Clinicians can make an individual funding request for a treatment if
it is a very new treatment or drug and has no commissioning policy available
there are exceptional reasons why the treatment or drug should be available to an individual patient.
A treatment may be funded on an individual basis if
The patient has a set of circumstances that are very different from anyone else meaning they will derive greater benefits from the intervention than others who are in a similar position
AND
There is good evidence to suggest that they would be healthier after the treatment or operation.
What are horizontal and vertical equity?
Horizontal equity: same provision for same need- equal access with no barriers
Vertical equity: greater provision for greater need
