SAS#9 Flashcards
– Equated to obligation to be fair in distribution of benefits and risks. “What is due to the
individual?”
– Maintenance of this principle simple in abstract and complex in application
– Reform of health care delivery, in regard to equity and access to health care services,
major issues. “What is fair? What is our due?”
Principle of Justice
Types of justice
Procedural justice or due process
Distributive justice
Compensatory justice
the idea of fairness in the processes that resolve disputes and
allocate resources (treating people w/ dignity & respect, being neutral in decision making; strict
tardiness policy with specific punishment)
Procedural justice or due process
fairness of the distribution of resources & outcomes (workers receiving equal
pay for equal work)
Distributive justice
the extent to which people are fairly compensated for their injuries by
those who have injured them (monetary compensation for victims of crimes or civil rights
violations)
Compensatory justice
In distribution, equals must be treated equally, and unequals must be treated unequally
(law)
Formal Justice
– Principles that specify relevant characteristics or morally relevant criteria in regard to
treatment are (morality & politics)
– Concerns the justice & injustice of the content of rules or laws
Material Justice
Common methods for distribution of goods and resources:
– To each person an equal share
– To each person according to need
– To each person according to merit
– To each person according to contribution
– To each person according to effort
– To each person according to social worth
– No persons granted social benefits on basis of undeserved advantage
– No persons denied social benefits on basis of undeserved disadvantages
– requires that persons “with similar abilities and skills should have similar life chances”
– that all should have a “fair chance” to attain success.
Fair Opportunity Rule
– Province of Congress, state legislatures, insurance companies, private foundations, and
health organizations
– Problems are demonstrated in such questions: What kind of health care available?
Who will get it & what basis? Who will deliver the services?
Macro-allocation
More personal determination of who will receive scarce resources such as intensive care
beds, organ transplants.
Micro-allocation
1.Everyone guaranteed coverage for basic care and catastrophic health needs
2. Is based on the ability to pay, would provide expanded & better care as private
Cultural and social barriers bar the way for many citizens to receive health care
Two-Tier System
Who shall be saved from drowning, and what will be the criteria for our selection?
Lifeboat Ethics
– Allocating scarce resources practiced and justified in crises of war or disaster
– Walking wounded
– Fatally wounded
– Seriously wounded
Triage
– Which patient has best prognosis?
– Often difficult to assess
Medical Utility
– Which patient has greatest social worth?
– Invites problems of racism, ageism, sexism, bias against retarded and mentally ill
Social Utility
Random selection treats all patients as equal
First Come, First Served
Theories of Justice
• Egalitarian
• Utilitarian
• Libertarian
• Emphasize equal access to goods and services
• Advocates of a right to health care
• Socialistic universal access health care systems
Egalitarian Theories:
maintains that for healthcare resources to be distributed fairly every person
should receive sufficient healthcare to provide them with the opportunity to live in good health for a
normal span of years.
Fair Innings argument
Criteria so public utility is maximized
Political planning and intervention methods of redistributing goods and wealth
Utilitarian theories:
greatest good for greatest number
Public utility
• Public utility: greatest good for greatest number
Utilitarian theories:
QALY:
quality adjusted life years
Measures cost-benefit of applying a medical procedure
QALY:
• Emphasize personal rights to social and economic liberty
• Choice of allocation system freely chosen
• Free-market system operates on material principle of ability to pay
Libertarian theories:
sees people are more enough to find and judge good ideas from bad. The
theory says people are rational and their rational thoughts lead them .
Libertarian theory
– Society spends 17.4 percent of gross domestic product on health care
– $2.9 trillion or $9,255 per person
– Per capita medical costs increased 1,000 percent
– Aging population places great burden on stressed system
– Use of high technology in medicine
Health care Crisis (USA)
WORLD HEALTH CARE MODELS: Religious, humanistic & transpersonal models
– Beveridge Model
– Bismarck Model
– National Health Insurance
– Out of Pocket
Beveridge Model
– Model originated in
Great Britain, practiced in Great Britain, Italy, Spain & Hongkong.
This model was first established by William Beveridge in United Kingdom
in 1948.
Beveridge Model
– Model originated in Great Britain, practiced in Great Britain, Italy, Spain & Hongkong.
– Health care financed by government and taxed based rather than insurance based
– No medical bills; health care treatment public service
– Strong emphasis on primary care
– health care system in which the government provides health care for all its citizens through
income tax payments.
– Costs controlled by rationing
– Long wait times for non-acute secondary and tertiary care
– Newest technologies not easily available
– Low costs per capita
– Government, as sole payer, controls what doctors can do and what they will charge
Beveridge Model
National Health Insurance what countries
• Canada, Australia, Taiwan, South Korea
• Health care providers private
• Payer is government-run insurance program all citizens pay into
• Insured residents entitled to same level of care
• No profit motive, no need to advertise, no expensive underwriting
• National system great leverage and market power to negotiate lower prices
National Health Insurance
• Majority of world’s nations do not have resources to provide health care services for their
citizens
• Well-connected and rich get medical care
• Poor do without
Out of Pocket
out of pocket, what countries
• Rural Africa, India, China, South America
• Law requires Americans to purchase health insurance
• Expands Medicaid rolls
• Establishes health-insurance exchanges to provide more competitive rates
• Provides subsidies to the poor and middle-class to assist them in purchasing a private plan
• Imposes billions in new taxes, mainly on the rich and health care industry
• Still most complicated, expensive, and inequitable health care system in developed nations
• National shortage of primary care physicians
• Disparity in reimbursement levels between Medicare and Medicaid
• Geography creates access maldistribution
Patient Protection and Affordable Care Act
• all citizens are automatically entitled to PhilHealth benefits, including comprehensive outpatient
services. PhilHealth will be responsible for purchasing all individual-based services, including
supplies, medicines, and commodities, as well as maintenance and operating expense of health
facilities
UHC Law (Universal Health Law)
The UHC Law, also known as
Republic Act No. 11223
aims to reduce the risk of
Filipinos being forced into poverty just because they can’t pay their medical bills, while
increasing access to quality health care for the poor and those living in remote areas.
UHC Law, also known as Republic Act No. 11223
top 10 causes of deaths
medical errors
top priority for health care providers
Health care quality assessment
