Ethics of resource allocation: instruments for rational decision making in support of a sustainable health care
David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Jack Alan Reynolds
Learn more about PhilPapers
Poiesis and Praxis 3 (4):296-309 (2005)
Objective: In all western countries health care budgets are under considerable constraint and therefore a reflection process has started on how to gain the most health benefit for the population within limited resource boundaries. The field of ethics of resource allocation has evolved only recently in order to bring some objectivity and rationality in the discussion. In this article it is argued that priority setting is the prerequisite of ethical resource allocation and that for purposes of operationalization, instruments such as need assessment and health technology assessment (HTA) are essential worktools for making more rational decisions. Thresholds (deduced from the need assessment and HTA) areâwithin this contextâguiding but not binding principles. Method: Discussion of theoretical concepts of not only priority setting, need assessment and HTA complemented by practical examples for showing the challenges and the need, but also the chances of a more explicit and transparent policy of resource allocation in health care. Results: Priority setting in health care is based on the values of equity, justice and solidarity. Health packages decisions are determined from medical need (the severity of the condition) and/or the appropriateness of medical interventions (their cost-effectiveness). With growing awareness that originally effective and cost-effective services and programmes are eventually provided inappropriately, the focus is shifting towards the organisational aspects of provision and application. Therefore, need assessment is based on the distinction of health care needs from demand, supply, or actual care. Additionally HTA provides the evidence on health care interventions in a way that it becomes obvious who benefits from an intervention and who definitely does not benefit, but eventually is harmed. Conclusions: Health services research on effective and cost-effective interventions and research/monitoring of performance that the effective and cost-effective services are provided appropriately are of increasing importance for guiding the decision-making process on priority setting and need assessment. Effective healthcare for all is sustainable, if we start to put expenditures in perspective and focus health policies and research strategies on managing expectations through patient information and a more realistic notion of medical advancements and, on the other hand, on encouraging need-based and cost-effective innovations
|Keywords||Resource allocation Priority setting Health technology assessment Need assessment Health policy|
|Categories||categorize this paper)|
Setup an account with your affiliations in order to access resources via your University's proxy server
Configure custom proxy (use this if your affiliation does not provide a proxy)
|Through your library|
References found in this work BETA
No references found.
Citations of this work BETA
No citations found.
Similar books and articles
Gavin H. Mooney & Alistair McGuire (eds.) (1988). Medical Ethics and Economics in Health Care. Oxford University Press.
David A. Gruenewald (2012). Can Health Care Rationing Ever Be Rational? Journal of Law, Medicine and Ethics 40 (1):17-25.
Tony Hope, Lars Peter Østerdal & Andreas Hasman (2010). An Inquiry Into the Principles of Needs-Based Allocation of Health Care. Bioethics 24 (9):470-480.
Erik Nord (1999). Towards Cost-Value Analysis in Health Care? Health Care Analysis 7 (2):167-175.
Rogeer Hoedemaekers & Wim Dekkers (2003). Key Concepts in Health Care Priority Setting. Health Care Analysis 11 (4):309-323.
Greg Bognar (2011). Impartiality and Disability Discrimination. Kennedy Institute of Ethics Journal 21 (1):1-23.
Jean-Paul Moatti (1999). Ethical Issues in the Economic Assessment of Health Care Technologies. Health Care Analysis 7 (2):153-165.
Lucy Frith (1999). Priority Setting and Evidence Based Purchasing. Health Care Analysis 7 (2):139-151.
Helen Keasberry (1992). Equity and Solidarity: The Context of Health Care in the Netherlands. Journal of Medicine and Philosophy 17 (4):463-477.
Veronika Wirtz, Alan Cribb & Nick Barber (2003). Understanding the Role of “the Hidden Curriculum” in Resource Allocation—The Case of the UK NHS. Health Care Analysis 11 (4):295-300.
Lorian E. Hardcastle, Katherine L. Record, Peter D. Jacobson & Lawrence O. Gostin (2011). Improving the Population's Health: The Affordable Care Act and the Importance of Integration. Journal of Law, Medicine and Ethics 39 (3):317-327.
Robert A. Pearlman (1992). An Ethical Framework for Rationing Health Care. Journal of Medicine and Philosophy 17 (1):79-96.
Doug Martin & Peter Singer (2003). A Strategy to Improve Priority Setting in Health Care Institutions. Health Care Analysis 11 (1):59-68.
Bjørn Hofmann (2005). On Value-Judgements and Ethics in Health Technology Assessment. Poiesis and Praxis 3 (4):277-295.
Søren Holm (1995). "Socialized Medicine", Resource Allocation and Two-Tiered Health Care – the Danish Experience. Journal of Medicine and Philosophy 20 (6):631-637.
Added to index2010-09-02
Total downloads15 ( #112,867 of 1,100,137 )
Recent downloads (6 months)4 ( #90,386 of 1,100,137 )
How can I increase my downloads?