Question

Could allocation decisions about access to health care be based on an ethical analysis, rather than dictated by market forces?

Answer 1

Definition:A method of organizing nursing care in which a nurse is allocated to care holistically for all the needs of a patient on a daily basis.

Types:

1.Macro-allocation – the case of IVF treatment

2.Micro-allocation – issues in organ transplantation

Macro allocation:-

1. Cost effectiveness

• What if we fund the most cost-effective treatments? This way, we can benefit the greatest number of people
• But, this would mean that it would be more important to fund tooth capping than appendectomies. We need to figure out a way to compare dissimilar treatments.

2. How beneficial is the treatment?

• We want to fund the things that will do the most good…i.e. that give the best net benefits
• But we also need to consider the starting point. What if we have two treatments that give equal net benefits, but one treatment is for a condition that is associated with poor functioning and the other with a condition that is associated with moderate functioning?

3. Medical Necessity

• A demarcation principle based on medical necessity says that we should fund only medically necessary treatments
• Freedman and Baylis: (a) this approach is intuitively plausible and in some cases is the only possible approach, but in other cases it “results in some obvious inequalities and distortions in government coverage practices” e.g. Jane Smith
• Freedman and Baylis: (b) We also need a concept of medical necessity. But it’s notoriously difficult to define health…
• WHO definition: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease.”
• Callahan: On this definition, crime, poverty and other social problems are medical problems…the definition is too inclusive
• Callahan: “Health is a state of physical well-being” which need not be perfect but is “at least adequate, i.e. without significant impairment of function.”
• But there are problems here, too: first, what about mental health? Second, the elderly, people with disabilities or people with chronic health problems pose problems for this definition.

Why is Resource Allocation needed?

Because of increasing demand for healthcare services and rising costs to provide those services,many people choose how to allocate healthcare dollars.

Rising cost of healthcare

Resources spent on healthcare have increased over the last century. Americans are spending far more resources on healthcare than do citizens of any other industrialized nation.

• Continued medical advances have lead to more accurate diagnoses and better treatments, but also have increased the cost of healthcare.

• The aging population is growing. Nearly 36 million Americans (more than the entire population of Canada) are age 65 or older and account for a majority of healthcare expenditures.

Responses and attempted solutions to the problem of limited healthcare resources

Since health is valued very highly in American society, there have been many attempts to reform the system. These reforms have attempted to either increase the financial resources directed to healthcare or to use limited resources in the best way possible. Reform attempts have included efforts to:

1. Increase efficiency. By curtailing waste and unnecessary care, providers can be more efficient. Methods include evaluating health technologies and expanding prevention programs.

2. Distribute resources equitably. The basis of distribution is value-based and can take many forms: strict equality, access to a determined level of care, access to an equal opportunity for care, limiting access to people responsible for their health problems, and access based on age or other factors.

3. Adopt managed care plans. Managed care has been offered as an organizational structure that hopes to distribute healthcare resources more efficiently and wisely by having physicians review policies that balance the healthcare of the individual patient (and the cost of caring for that patient) with the goals and costs of providing healthcare to the entire group.

Ethical Issues

A number of ethical questions arise when discussing healthcare resource allocation:

• If healthcare resources are scarce, how should they be distributed?

• Distribution choices will benefit some and not others. How should choices be made? What values should guide these choices?

• Could Americans devote more resources to healthcare if they chose?

• Does America spend too much on healthcare? What about in comparison to other countries?

• Is the current distribution of healthcare resources fair and equitable?

• Is the current distribution of healthcare resources an efficient and wise use of funding.