Managing Health Resources - Chapter 5
Randall argues that
- Healthl care rationing is necesssary
- Each patiente is owned a fair share of the health care resources
- Rationing should be based on the good of the patient on the whole , not just the good of the
patientes on a one-byond basis.
• That is community good rather than medical good of a specifc patient
Randall sees practitioners as trusters
- a truster is somone entrusted to administer property or resources for the benefit of another
person, persons or instituions.
As Randall notes.
- a practionoer sees many patients in a given year.
- each patient is owed a fair of the practitioner's resources
- a practitioner's resources (consultation, assesment, follow-up referrals, etc) are a fixed.
- there is a practical limit per day, per week, per month, etc.
- rationing is necessary between patients.
For example, on aparticular day, two patients may benefit from admission to hospital for
observation, but a bed is avaliable for only one of them.
- rationing essults in one patient receving a higher degree of care than the other.
- This is unpleasent but unavoidable.
- Each patient is owed a fair share if the avaliable resources, but not necessarily na equal share.
Randall sees health care provider in a community as a single team entrusted to provide fair
distribution of health care services.
- She cautions that it may be difficulty for members of different professions to agree on
treatment priorities and rationing policies.
- Resources allocation decision may vary between communities something she calls "rationing
by poste code"
- governmental policie are required to avoid large regional disparities.
Is summary, health care providers should be "good team players", ...
- Cooperation between professional
- respect for teams decisions
- aim to provide best use of health care resources (macro allocation)
- aim to provide fair distribution therapeutic benefit (micro allocation)
- decision about which services and treatment are provided.
Health has a broad definition
"a state of complete physical, mental and social well-being, and not merely the abscent of
disease or infirmity." "But even a much narrower definition would not make clear which services and treatments
shoud be provided."
Similarly, the concept of need does not define which services and treatments ....
For example, one might say...
- A need something without one will be fundamentally harmed"
In this case, we would provide treatments and services that prolong life, or prevent
suffering or disability.
However, as Randall notes, it is unclear that a desire to hove a child is a "need" that if
unsatisfied will leas to fundamental harm.
A broader definition of "need" could be a "a capacity to benefit"...
- this would include routine assessment of blood pressure, cholesterol levels, etc.
- this could also enconpass good housing, rewarding employment, a healhty lifestyle, etc.
- A Randall comments, "health services would have to be infinite"
Masow (1954) described "needs" in terms of hierarchical system, in which basic level needs
must be me