Justice Issues in Health Care Some slides modified from Maureen - - PDF document

Macroallocation and Economic Justice Medical Ethics 1

Justice Issues in Health Care

Some slides modified from Maureen Giacomazza, RN

Limiting Resources

Macroallocation – large-scale decisions that

are made regarding the use of medical resources, do not involve individuals directly.

Largely the domain of the government,

insurance companies and private foundations.

Limiting Resources

Microallocation – small scale decisions that

are made everyday and directly impinge on individuals. Examples:

Who will get the ICU bed? Who will get in to see the doctor today? Which surgery will be cancelled to make room

available for the emergency patient?

Macroallocation and Economic Justice Medical Ethics 2 Historical perspective

Renal dialysis Available since early 1960’s, but machines

were few and expensive.

Munson discusses a “selection committee” for

choosing who will receive dialysis and who will not.

Do you think this is a “just” way of

distributing scarce resources? What other criteria should we use?

Historical perspective

Congress stepped in to make a

macroallocation decision to cover the costs

• f dialysis.

Now dialysis and kidney transplants are

covered under Medicare.

Present costs of this program alone is over

$8 billion/year.

The Health Care Crisis

Macroallocation and Economic Justice Medical Ethics 3 The Health Care Crisis

Health care expenditures in the U.S. far exceed those in any other industrialized country. U.S. spends 14% GNP Japan 6.8% GNP Greece 4.8% GNP

The Health Care Crisis

Single-payer plans such

as Canada’s spend approximately 12% on administrative costs.

The U.S. spends 25-30%

• f all our health care

dollars on multiple-payer administrative costs.

Disturbing Facts

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Macroallocation and Economic Justice Medical Ethics 4 Questions

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Public Goods and Private Goods

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President’s Commission: Health Care Is Special

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President’s Commission: Equitable Health Care

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Rawls’ approach: A Theory of Justice

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What Rules Would We Adopt?

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Other Possibilities for Reducing Costs

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