PSYCH M140 Chapter Notes - Chapter 4: Daniel Callahan, Dialysis, Health Care Rationing
CONTROVERSY 4: SHOULD WE RATION HEALTH CARE FOR OLDER PEOPLE?
Should we ration
health care for
older people?
• Americans over age 65 account for one-third of all national health care
expenditures
• But rationing health care on the basis of age alone is troubling to most
Americans
o How are we to justify spending large amounts of money
prolonging the lives of the older adults? Who will get access to
expensive health care resources?
§ These questions don’t have easy answers
Precedents for
health care
rationing
• Has rationing health care ever been done before? Is it likely to be
introduced in the United States?
o Denial of kidney dialysis in Britain—kidney dialysis has been
routinely withheld from people over age 55
o Waiting lines in Canada—for some procedures (like non-life-saving
surgery) it may be necessary to wait long periods
o Life-and-death decisions in Seattle—hospitals used to have
special committees that decided who would have access to dialysis
o A rationing plan in Oregon—for health care problems covered by
the state’s Medicaid program, funding is available and services are
rationed not according to individual cases, but according to a consensus
reached by democratic means and a computer-based ranking of
severity
The justification for
age-based
rationing
• There are many ways to ration health care besides age:
o Ability to pay
o Anticipated clinical effectiveness
o Waiting lists
o First come, first served
o Productivity to society or social worth
• But rationing based on age might be better:
§ It would be efficient to administer
§ Older people are less productive in the economy
§ All people are members of every age group at some time
Rationing as a
cost-saving plan
• Difficult to determine how much money would be saved
o The majority of money spent on health care goes to prescription
drugs, nursing home care, and home health services
• The rapid rise in health care costs is not solely due to longevity;
also due to the following:
o Increases in intensity and rates of utilization
o Introduction of new medical technologies
o Rise in real wages of health care personnel
o General price inflation
o Fraud, waste, abuse, and futile medical treatment
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The impetus for
rationing
• A big part in the rationing debate is economics —the science of
scarcity
o Only when scarcity is at hand is rationing seriously considered
• The “oldest-old”—those over age 85—have the greatest number of
health problems and cost the most in terms of health care
o If expensive health care resources were rationed on the grounds of
age, as philosopher Daniel Callahan (1987) recommends, then this age
group would be denied health care
Cost versus age
• We often end up spending more and more money to achieve small
gains, usually with a remaining poor quality of life, while other social
needs go unmet
o Callahan believes that society owes older adults a decent
minimum of health care—at least up to a certain age
• Critics of Callahan argue that age-based rationing actually affects
only those who depend on government-run health care programs—
that is, older people who can’t afford private care
o Callahan believes we already have an “invisible” form of rationing
in place, and it would be better to make it overt and public, rather than
hidden and invisible
Alternative
approaches to
rationing
• Possible alternative approaches to rationing include the following:
o Limit medical procedures based on effectiveness as measured
by health outcomes research
o Cost-benefit analysis—determine how much a treatment costs in
comparison with the total benefit that will be created if the patient
lives
o Cost-effectiveness analysis—looks at which treatment provides
the desired outcome for the least cost
o Quality-adjusted life years (QALY)—the commonsense view that 10
years of life with disability may not have the same value as 10 years
of good health
Reading 16: Why We Must Set Limits
Callahan’s book Setting Limits was first published, it was considered quite controversial. What
are the main points of his argument and what would society look like if his recommendations
were implemented?
The medical progress we usually hail: a triumph of medical technology and a newfound
benefit provided by an established health care program
A government campaign for cost containment was under way, with a special focus on
Medicare
Medicare and Medicaid are grossly inadequate in meeting the real and full needs of the elderly
THESIS: even with relatively ample resources, there will be better ways in the future to
spend our money than on indefinitely extending the life of the elderly
_”the place of the elderly in a good society is a communal”
_the greatest obstacle: our inability to find a meaningful place in public discourse for
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Rationing as a cost-saving plan: americans over age 65 account for one-third of all national health care expenditures, but rationing health care on the basis of age alone is troubling to most. Older people are less productive in the economy. Callahan"s book setting limits was first published, it was considered quite controversial. The medical progress we usually hail: a triumph of medical technology and a newfound benefit provided by an established health care program. A government campaign for cost containment was under way, with a special focus on. Medicare and medicaid are grossly inadequate in meeting the real and full needs of the elderly. Thesis: even with relatively ample resources, there will be better ways in the future to spend our money than on indefinitely extending the life of the elderly. _ the place of the elderly in a good society is a communal .
