Rationing in health care The Utility of Ignorance卫生保健的配给无知的效用.pptVIP

Rationing in health care With indebtedness and gratitude to Joanna Coast, Department of Social Medicine, University of Bristol, for writing a book, PhD thesis and presentation on priority-setting…… and for allowing me to plagiarise it all!!!! Rationing in health care What does ‘rationing’ mean? Rationing with respect to efficiency or equity? Implicit versus explicit rationing Methods and examples of explicit rationing Rationing: what’s in a name? Economics concerned with choice between competing alternatives Based on axiom of scarcity - resources limited relative to wants Fundamental ‘economic problem’ is therefore allocation of these scarce resources ‘Rationing’ (and priority-setting) just another term for resource allocation Rationing: what’s in a name? “The word [rationing] is invoked to make the flesh creep, not to prompt argument about how to deal with the inescapable” Rudolph Klein, 1992 Means of rationing Market system - price mechanism establishes equilibrium (efficient allocation) Non-market system - absence of price as allocative tool leads to other, non-price, techniques Issue is one of: (i) philosophical basis for rationing; and (ii) applied technique for rationing ‘Philosophical’ basis of rationing Price system - objective = efficiency consumer sovereignty allocation by WTP/ATP Non-price - objective efficiency or equity’? who decides on allocation? allocation by what criteria? Objective: efficiency or equity? Efficiency maximisation of ‘benefit’ utilitarian ethic distribution is irrelevant Equity just distribution based on need? age? lottery? Objective: efficiency or equity? Philosophical basis price system/efficiency is utilitarianism Other philosophical bases are generally pursued in non-price allocation Which do we adopt? Three important ethical theories Utilitarian - greatest good for greatest number (maximise ‘utility’ or ‘happiness’) Deontological - cannot ignore duty to one individual for sake of good of others