Should organ transplants be given to patients who have waited the longest, or need it most urgently, or those whose survival prospects are the best? The rationing of health care is universal and inevitable, taking place in poor and affluent countries, in publicly funded and private health care systems. Someone must budget for as well as dispense health care whilst aging populations severely stretch the availability of resources. The Ethics of Health Care Rationing is a clear and much-needed introduction to this increasingly important topic, considering and assessing the major ethical problems and dilemmas about the allocation, scarcity and rationing of health care. Beginning with a helpful overview of why rationing is an ethical problem, the authors examine the following key topics: What is the value of health? How can it be measured? What does it mean that a treatment is "good value for money"? What sort of distributive principles - utilitarian, egalitarian or prioritarian - should we rely on when thinking about health care rationing? Does rationing health care unfairly discriminate against the elderly and people with disabilities? Should patients be held responsible for their health? Why does the debate on responsibility for health lead to issues about socioeconomic status and social inequality? Throughout the book, examples from the US, UK and other countries are used to illustrate the ethical issues at stake. Additional features such as chapter summaries, annotated further reading and discussion questions make this an ideal starting point for students new to the subject, not only in philosophy but also in closely related fields such as politics, health economics, public health, medicine, nursing and social work.

A rational look at health care rationing, from ethical, economic, psychological, and clinical perspectives. Although managed health care is a hot topic, too few discussions focus on health care rationing--who lives and who dies, death versus dollars. In this book physician and bioethicist Peter A. Ubel argues that physicians, health insurance companies, managed care organizations, and governments need to consider the cost-effectiveness of many new health care technologies. In particular, they need to think about how best to ration health care. Ubel believes that standard medical training should provide physicians with the expertise to decide when to withhold health care from patients. He discusses the moral questions raised by this position, and by health care rationing in general. He incorporates ethical arguments about the appropriate role of cost-effectiveness analysis in health care rationing, empirical research about how the general public wants to ration care, and clinical insights based on his practice of general internal medicine. Straddling the fields of ethics, economics, research psychology, and clinical medicine, he moves the debate forward from whether to ration to how to ration. The discussion is enlivened by actual case studies.

In one form or another, health care now gets rationed. Not everything beneficial is done for every patient. For the individual the consequences are sometimes tragic. Rationing decisions thus raise a classic dilemma: how can we treat with dignity and genuine respect the person who gets short-changed by an efficient policy that seems best overall? Strong Medicine argues that we can, if those policies represent the hard trade-off preferences of patients controlling resources for their larger lives. Rationing is still strong medicine to swallow, but then it becomes what patients as well as the doctor ordered. Menzel develops this central idea and applies it to major issues of health policy and economics: the notion of pricing life, the long-run cost of prevention, measuring quality of life, imperiled newborns, adequate care for the poor, containing costs by market competition, malpractice suits, procuring organs for transplant, and dying expensively in old age. He provides a hard-hitting, critical philosophical discussion of these issues, in non-technical language accessible to a wide range of readers interested in policy questions the book takes up. The issues are fascinating, the arguments are careful, and the results often surprising.

A clearly written and well structured textbook, providing an introduction to decision making and priority setting, this title brings together theories, practice and evidence from a wide range of disciplines.

This volume explains why, and in what ways, health care is being rationed in the late-1990s health service. It examines the ethical questions which arise from this rationing and includes personal case studies, from surgeons to geriatric advisors.

This comprehensive textbook analyzes the ethical issues of health and health care in global perspective. Ideal for students of public health, medicine, nursing and allied health professions, public policy, and ethics, the book helps students in all these areas to develop important competencies in their chosen fields. Applying a comparative, or multicultural, approach, the book compares different perspectives on ethical issues in various countries and cultures, such as informed consent, withholding or withdrawing treatment, physician-assisted suicide, reproductive health issues, research with human subjects, the right to health care, rationing of limited resources, and health system reform. Applying a transnational, or cross-border, approach, the book analyzes ethical issues that arise from the movement of patients and health professionals across national borders, such as medical tourism and transplant tourism, ethical obligations to provide care for undocumented aliens, and the “brain drain” of health professionals from developing countries. Comprehensive in scope, the book includes selected readings which provide diverse perspectives of people from different countries and cultures in their own words. Each chapter contains an introductory section centered on a specific topic and explores the different ways in which the topic is viewed around the globe. Ethics in Health Services and Policy is designed to promote student participation and offers methods of activity-based learning, including factual scenarios for analysis and discussion of specific ethical issues.

Budgets of governments and private insurances are limited. Not all drugs and services that appear beneficial to patients or physicians can be covered. Is there a core set of benefits that everyone should be entitled to? If so, how should this set be determined? Are fair decisions just impossible, if we know from the outset than not all needs can be met? While early work in bioethics has focused on clinical issues and a narrow set of principles, in recent years there has been a marked shift towards addressing broader population-level issues, requiring consideration of more demanding theories in philosophy, political science, and economics. At the heart of bioethics' new orientation is the goal of clarity on a complex set of questions in rationing and resource allocation. Rationing and Resource Allocation in Healthcare: Essential Readings provides key excerpts from seminal and pertinent texts and case studies about these topics, contextualized by original introductions. The volume is divided into three broad sections: Conceptual Distinctions and Ethical Theory; Rationing; and Resource Allocation. Containing the most important and classic articles surrounding the theoretical and practical issues related to rationing and how to allocate scare medical resources, this collection aims to assist and inform those who wish to be a part of bioethics' 21st century shift including practitioners and policy-makers, and students and scholars in the health sciences, philosophy, law, and medical ethics.

Adds to the debate on priority setting by looking at experience from other countries.

This book explores the making of health care rationing decisions through the analysis of three alternative decision makers: patients paying out of pocket; officials setting limits on treatments and coverage; and physicians at the bedside. Hall develops this analysis along three dimensions: political economics, ethics, and law. The economic dimension addresses the practical feasibility of each method. The ethical dimension discusses the moral aspects of these methods, while the legal dimension traces the most recent developments in jurisprudence and health law.

'Medical need' is a factor in health care access decision-making, but merit-considerations are becoming important too. In the shortening of waiting time, priority arrangements are considered and/or introduced, based on non-medical criteria. Simultaneously, in terms of financing, health status has become important due to payment arrangements, limited insurance package options, etc. At the same time, health status disparities, due to socioeconomic inequalities, seem to be increasing. Under these circumstances, confronted with increased health spending, it is expected that rationing will become more eminent. Due to this, the emerging relevant questions are: Who will be responsible for rationing (the market, governments, bureaucrats, physicians, or others)? * How does it function (explicit or implicit)? * What are relevant and acceptable selection criteria (QUALYs, DALYs, health status, sex, age, etc.)? * To what extent is current rationing just? * What can be done to make it more just? *