Summarizing Population Health Directions for the Development and Application of Population Metrics (1998) / Chapter Skim
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Appendix D: Distributive Justice and the Use of Summary Measures of Population Health Status
Appendix D: Distributive Justice and the Use of Summary Measures of Population Health Status
Pages 58-72
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From page 58... ...
When should we allow modest benefits to many people to outweigh significant benefits to fewer? When should we allocate resources to produce "best outcomes" and when should we give people fair chances at some benefit?
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From page 59... ...
. Unfortunately, simply malting Hat recommendation without providing more assistance in helping us make these controversial, distributive decisions risks letting people give too much weight to He distributive implications of CEA.
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From page 60... ...
Suppose, however, a MCO used a formal CEA—with QALYs or DALYs or some other summary population health measure- to compare the new technology to the standard one. If the CEA shows they get the same or greater health benefit per dollar spent with the new technology, the MCO can make a completely noncontroversial distributive decision.
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From page 61... ...
It is also the problem facing the World Bank when it evaluates which health care investments it should make among alternatives proposed for a developing country' or the problem faced by a country considering whether to accept a World Bank loan that uses CEA to impose certain priorities.) Some of these distributive questions' as Brock suggests In his paper, result from the fact that different summary measures incorporate distinctive assumptions that have recognized distributive effects on different population groups.
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From page 62... ...
The weighings that different people give to different moral concerns, such as helping the worst-off versus not sacnfic~ng achievable medical benefits, probably depend on how these moral concerns fit within wider moral conceptions people hold. If so, there is good reason to think these disagreements will be a persistent feature of the situation.
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From page 63... ...
One appendectomy is more important than one tooth capping because it saves a life rather Man merely reduces pain and preserves dental function. Our intuitions are much less developed when it comes to making one to many compansons.
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From page 64... ...
When the Swedish government set up a commission to establish principles for establishing priorities in its health care system, it gave great weight to helping the sickest or most disabled individuals, probably much more weight than other societies considering the same question would give, and more weight than many of my students polled on the issue were willing to give. Even if there are principled solutions Nat philosophical investigation may eventually uncover, there is considerable disagreement now and among different groups about how to solve these problems.
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From page 65... ...
person trade-off approach to valuing alternative health care programs addresses explicitly the distributive questions that need answers. By directly surveying people's attitudes toward trade-offs between allocating resources to groups that differ in their initial health state and ultimate health outcomes, Nord hoped to uncover the structure of our moral concern or our values regarding how much priority to give sickest patients.
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From page 66... ...
In this case, aggregating preferences through the mechanism of voting is a way to achieve the greatest net satisfaction of preferences, since Me frustration of the vanilla lovers is offset bY the greater pleasure of the chocolate lovers. Abiding by a majority decision that compels people to act in ways that are counter to their fundamental beliefs about what is morally right is not, however, simply like frustrating a taste for vanilla ice cream.
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From page 67... ...
The basic intuition behind it is that institutions making decisions about resource allocation—as MCOs do when they make coverage decisions—should meet several conditions that impose what I call "public accountability for reasonableness." These conditions connect deliberations about how to address distributive issues made by private organizations (or public agencies) to a broader social deliberation that involves broader democratic processes.
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From page 68... ...
The guiding idea behind the four conditions is to convert private MCO solutions to problems of limit-setting and resource allocation—where highly controversial moral issues are at stake—into part of a larger public deliberation about a major, unsolved public policy problem, namely, how to use limited resources to protect fairly the health of a population with varied needs, a problem made progressively more difficult by the successes of medical science and technology. If met, these conditions help these private institutions to enable a more focused public deliberation Cat involves broader democratic institutions.
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From page 69... ...
3. A distinct minority of students and health professionals would argue as follows: if helping the better-off patient B actually reds B to a level of functioning that permits her to work and carry out other social functions, whereas helping He sicker patient A does not accomplish this outcome, Hen it is more unportant to help B
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From page 70... ...
1988. "Ethical Issues in Recipient Selection for Organ Transplantation." In D
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From page 71... ...
1993. "The Relevance of Health State after Treatment in Pr~ontiz~ng between Different Patients." Journal of medical Ethics ~ 9:37~2.
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