No CrossRef data available.
We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
Published online by Cambridge University Press: 08 January 2010
How much by way of economic reward is due to health care providers?
Although this problem usually presents itself as a practical matter of policy, it has buried within it a number of philosophical issues, for it can be regarded as a question in the theory of economic justice. The formal principle of justice is that we should render persons what is due to them. But on what consideration in the case of health care providers can we make an assessment of what is due?
The answer we give to this question has significant implications for the ethical appraisal of the allocation of resources in the health care system. Some of the most difficult issues of ethical appraisal emerge when we consider the problems of allocating potentially life-saving resources between different groups of patients. Many of the most significant current issues in medical ethics—the role of QALYs, the meaning of equality and the economic evaluation of life—find their point of reference in the ‘tragic choices’ that are created when there are insufficient resources to meet apparently legitimate medical need. Yet, as Robert Evans has pointed out, it is a simple matter of accounting identity that health care expenditures must equal health providers' incomes. So, in asking how we limit or allocate costly health care resources, we are implicitly offering an answer to the question of how much we should pay providers. I hope by seeking an answer explicitly to that question to throw light on the problems that are raised when considering ethically the allocation of health care resources.
1 Calabresi, G. and Bobbitt, P., Tragic Choices (New York: Norton, 1978).Google Scholar
2 Evans, Robert G., ‘The Spurious Dilemma: Reconciling Medical Progress and Cost Control’, Quarterly Journal of Health Service Management 4 No. 1 (1986), 25–34.Google ScholarPubMed
3 Challah, S., Wing, A. J., Bower, R., Morris, B. and Schroeder, S., ‘Negative Selection of Patients for Dialysis and Transplantation in the United Kingdom’, British Medical Journal 288 (1984), 1119–1122.CrossRefGoogle ScholarPubMed
4 President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioural Research, Securing Access to Health Care: Ethical Implications of Differences in the Accessibility of Health Services (Washington, DC: Government Printing Office, 1983).Google Scholar
5 Evans, Robert G., ‘Health Care in Canada: Patterns of Funding and Regulation’, in McLachlan, G. and Maynard, A. (eds), The Private / Public Mix for Health (London: Nuffield Provincial Hospitals Trust, 1982), 369–424.Google Scholar
6 DHSS, The Health Service in England, Annual Report 1985–86 (London: HMSO, 1986).Google Scholar
7 Brittan, Samuel, ‘The Economic Contradictions of Democracy’, in King, A. (ed.), Why is Britain Becoming Harder to Govern? (London: BBC, 1976).Google Scholar
8 O'Higgins, Michael, Health Spending—A Way to Sustainable Growth (London: Institution of Health Service Management, 1987).Google Scholar
9 Review Body on Doctors' and Dentists' Remuneration, Sixteenth Report, 1986 Cmnd. 9788 (London: HMSO, 1986).Google Scholar
10 Menzel, Paul (1983), Medical Costs, Moral Choices (New Haven, Conn.: Yale University Press, 1983).Google Scholar
11 Ibid.
12 Daniels, Norman, Just Health Care (Cambridge University Press, 1985).CrossRefGoogle ScholarPubMed
13 Ibid.
14 Weale, Albert, Political Theory and Social Policy (London: Macmillan, 1983).CrossRefGoogle Scholar
15 Ibid.
16 Marmor, T. R., Political Analysis and American Medical Care (Cambridge University Press, 1983).Google Scholar