WEEK 3: Equity and Justice Flashcards
Q: What is the difference between the need for healthcare and the need for health?
A: The need for healthcare should be distinguished from the need for health. The need for health is broader and encompasses various health-related issues, including problems for which there may not be a known treatment or cure.
Q: When does a need for healthcare exist?
A: A need for healthcare exists when an individual has an illness or disability for which there is an effective and acceptable treatment or care available.
Q: How is need often defined in healthcare?
A: Need is often defined as the “capacity to benefit.”
This means that the individual has the potential to experience a positive health outcome through the utilization of healthcare services.
However, the capacity to benefit is not fixed and can be influenced by factors such as current knowledge, the research agenda, and cultural and ethical determinants.
Q: How are demand and supply defined in healthcare?
A: Demand refers to what individuals ask for in terms of healthcare services or treatments.
On the other hand, supply refers to what is provided, or the services that are available to meet the demands of individuals.
Discuss the 4 types of needs and give examples of each.
- Normative need: Need that is defined by experts. Normative needs are not absolute and there may be different standards laid down by different experts.
EXAMPLES: Vaccinations, a decision by a surgeon
that a patient needs an
- Felt need: Need perceived by an individual. Felt
needs are limited by individual perceptions and knowledge of services.
EXAMPLE: Having a headache, feeling knee pain
- Expressed need (Demanded need): Felt needs turned into action. Help seeking.
EXAMPLES: Going to the dentist for a toothache
- Comparative need: Needs identified by comparing the
services received by one group of individuals with those received by another comparable group.
EXAMPLE: A rural village may identify a need for a well or a school if the neighboring village has one
Prioritising some health care interventions over others (and
some individuals over others) are difficult choices
◦ There is no obvious set of ethical principles or analytical tools to determine what decisions should be made at which level of the health system, or how to allocate limited resources.
◦ Four Principles framework, one of the most widely used
frameworks in decision making. ◦ In any given situation, the four different (and often competing) principles compete for importance
Discuss the 4 principles framework.
- Beneficence: Doing or bringing about good
- Non-maleficence: The avoidance of doing harm
- Autonomy: Respecting the decision-making capacities
of autonomous persons; enabling individuals
to make reasoned informed choices. - Justice: Distributing health care fairly and justly
(However, Concepts of Need, justice are a moral decision rather than an objective one)
Discuss the Four principles of “accountability for reasonableness”
- 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.
Q: How are economic evaluations, such as cost-benefit analysis and cost-effectiveness analysis, used in healthcare?
A: Economic evaluations, including cost-benefit analysis and cost-effectiveness analysis, are used by many countries in rationing healthcare. These evaluations help inform health policy decisions by assessing the costs and benefits of different interventions or strategies. They provide a framework for comparing the value of different healthcare options and allocating resources efficiently.
Q: What role do value judgments play in economic evaluations?
A: Value judgments are a key part of any economic evaluation.
They involve making decisions about which costs, benefits, and effects should be included in the analysis.
Value judgments can vary depending on the perspective and priorities of decision-makers. They influence the selection of relevant outcomes and the assignment of monetary values to those outcomes.
Q: What is the potential limitation of prioritizing health services based solely on economic evaluations?
A: Prioritizing health services based solely on economic evaluations, such as cost-effectiveness analysis, favors services that deliver the greatest benefit to the most people at the lowest cost. This approach aligns with a Utilitarian perspective.
However, it may not consider other principles of social justice or the preferences and values of the public.
Different individuals or communities may have different priorities and may identify alternative choices based on principles other than cost-effectiveness alone.
What is efficiency?
Efficiency refers to the allocation of limited economic resources to meet the healthcare needs of a society.
◦ Equity is always an important criterion for allocation of
resources.
◦ It is observable that people attach more importance to equity in health and health care than they do to many other goods and services.
◦ Equity is an important policy objective in almost every health care system in the world.
Define EQUITY.
Fairness
Q: What is the aim when prioritizing healthcare in terms of efficiency and equity?
A: The aim when prioritizing healthcare is to achieve efficiency, which means maximizing health benefits given limited resources, while also ensuring equity, which refers to the fair distribution of resources. The goal is to balance these two objectives to optimize healthcare delivery.
Q: Are equity and efficiency mutually exclusive in healthcare systems?
A: Some market economists may argue that equity and efficiency are mutually exclusive.
However, this argument does not necessarily apply to healthcare systems.
In fact, the 2000 World Health Report identified both equity and efficiency as important measures of a good health system.
It is possible to strive for both equity and efficiency in healthcare, although finding the right balance can be challenging.
Q: Is there a consensus on how to develop health policies that achieve maximum health gains while distributing resources fairly?
A: No, there is no consensus on how to develop health policies that deliver maximum health gains while distributing resources fairly.
Balancing efficiency and equity in healthcare is a complex task that involves value judgments and trade-offs.
Different stakeholders may have different perspectives on what constitutes a fair distribution of resources.
Achieving this balance requires ongoing discussions, considerations of various ethical principles, and engagement with the public to understand their preferences and values.
EXAMPLE
◦ In the UK general practitioners receive a payment for every
woman screened for cervical cancer.
◦ In spite of this incentive to universally offer cervical screening, some population groups (particularly disadvantaged groups) continue to have very low participation rates.
◦ More cases of cervical cancers would be avoided if targeted payments were introduced to general practitioners in order to increase screening rates equally in all socio-economic groups.
