2009-02-03-resources
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3 February 2009 E-Economics
PUSH Post Public United for Savings in Healthcare
Principles for allocation of scarce medical interventions Persad G, Wertheimer A, Emanuel EJ The Lancet, Volume 373, Issue 9661, Pages 423 - 431, 31 January 2009 "In health care, as elsewhere, scarcity is the mother of allocation. ... the scarcity of many specific interventions—including beds in intensive care units, organs, and vaccines during pandemic influenza—is widely acknowledged. ... We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems."
Allocation of scarce medical resources can be made on the basis of four principles, each of which can again be considered from two perspectives. The
authors recommend a system that "combines four morally relevant principles: youngestfirst, prognosis, lottery, and saving the most lives. In pandemic situations, it also allocates scarce interventions to people instrumental in realising these four principles." The authors do not make any distinction between situations that are perennially present - ICU beds, organ transplantation and such - and those that are episodic infectious epidemics. The former can be handled a little more leisurely, with time for the formation of expert committees and for examining the evidence. The real challenge lies in handling unplanned epidemics and disasters where there is seldom time to establish rules and implement them.
Dr Arjun Rajagopalan
PUSH Post
3 February 2009
While on the topic of resource allocation it is worthwhile taking a quick look at another paper that examined the priorities for spending for common healthcare problems. Using an opinion poll questionnaire, the authors of this report surveyed 253 health professionals from six countries, asking them to rank ten health interventions in order of priority for spending from most important (rank 1) to least important (rank 10). A summary of the intervention rankings, pooled across countries, is shown in the chart alongside. The key values on which this ranking was based emerged as follows: 1. Fair innings. At the top (most important priority for spending), participants favoured giving priority in spending to children. 2. Prevention. The strongest and most consistently shared value across countries was a general preference for preventive health care over curative care. 3. Individual responsibility. Typically, smokers were "blamed" for their cancer and were regarded as the least deserving of health-care spending. 4. Rule of rescue. Participants were willing to invoke the "rule of rescue" —the moral imperative to save the life of an identified individual who would otherwise die. What drives health-care spending priorities? An international survey of health-care professionals PLoS Med 4(2): e94Salkeld G, Henry D, Hill S, et al
Dr Arjun Rajagopalan
Much more at:
PUSH Post Public United for Savings in Healthcare
Principles for allocation of scarce medical interventions Persad G, Wertheimer A, Emanuel EJ The Lancet, Volume 373, Issue 9661, Pages 423 - 431, 31 January 2009 "In health care, as elsewhere, scarcity is the mother of allocation. ... the scarcity of many specific interventions—including beds in intensive care units, organs, and vaccines during pandemic influenza—is widely acknowledged. ... We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems."
Allocation of scarce medical resources can be made on the basis of four principles, each of which can again be considered from two perspectives. The
authors recommend a system that "combines four morally relevant principles: youngestfirst, prognosis, lottery, and saving the most lives. In pandemic situations, it also allocates scarce interventions to people instrumental in realising these four principles." The authors do not make any distinction between situations that are perennially present - ICU beds, organ transplantation and such - and those that are episodic infectious epidemics. The former can be handled a little more leisurely, with time for the formation of expert committees and for examining the evidence. The real challenge lies in handling unplanned epidemics and disasters where there is seldom time to establish rules and implement them.
Dr Arjun Rajagopalan
PUSH Post
3 February 2009
While on the topic of resource allocation it is worthwhile taking a quick look at another paper that examined the priorities for spending for common healthcare problems. Using an opinion poll questionnaire, the authors of this report surveyed 253 health professionals from six countries, asking them to rank ten health interventions in order of priority for spending from most important (rank 1) to least important (rank 10). A summary of the intervention rankings, pooled across countries, is shown in the chart alongside. The key values on which this ranking was based emerged as follows: 1. Fair innings. At the top (most important priority for spending), participants favoured giving priority in spending to children. 2. Prevention. The strongest and most consistently shared value across countries was a general preference for preventive health care over curative care. 3. Individual responsibility. Typically, smokers were "blamed" for their cancer and were regarded as the least deserving of health-care spending. 4. Rule of rescue. Participants were willing to invoke the "rule of rescue" —the moral imperative to save the life of an identified individual who would otherwise die. What drives health-care spending priorities? An international survey of health-care professionals PLoS Med 4(2): e94Salkeld G, Henry D, Hill S, et al
Dr Arjun Rajagopalan
Much more at:
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