Learning Objectives

Students should have some understanding of the following factors which influence the
allocation of resources in healthcare.

• Why allocation of resources is an ethical issue

1.WHY IS NEED GROWING
•Changes in demography
•The dynamic nature of need
•Changes in the perceptions of health
•The ‘myth’of infinite demand

2.HOW HEALTH CARE RATIONED

1.Withdrawal

2.Denial/restriction

3.Improving efficiency and effectiveness

4.Deterrence

5.Dilution

6.Deflection

3.ETICAL CONSIDERATION A) UTILITARIANISM

–the ethically correct action will be that

which results in the maximum overall
benefit orthe greatest good for the
greatest number
 –favours resources being allocated to
less expensive treatments or services
that provide the greatest benefit.

•Criticism: fails to take into account the

'need' for healthcare intervention and
relies rather on cost effectiveness.

•Practical application of the theory:

–Quality Adjusted Life Years (QALYs):
quantifying the net benefit from health
care interventions to allow comparison
of different interventions

2) DEONTOLOGY

–Focuses on patient autonomy

–Giving the patients the treatment they
want

• Systems used for determining the allocation of resources

– Market Forces –ABILITY TO PAY

– Desert –TREATMENT ACCORDING UNIT
– Contribution to Society –TREATMENT ACCORDING TO SOCIAL VALUE IS
VARIATION OF MERIT CRITERION
– Lottery
– Justice

• The Rationing Debate

MAIN BASIC PHILOSOPHICAL PRINCIPLE-----JUSTICE

– Needs principles
– Maximising principles
– Egalitarian principles
1.NEED PRINCIPLES
1.Distribution in proportion to degree of
immediate threat to life.
2.Distribution in proportion to degree of
immediate ill-health
3.Distribution in proportion to lifetime ill-
health
4.Distribution in proportion to immediate
capacity to benefit.
5.Distribution in proportion to lifetime
capacity to benefit
6.Distribution in proportion to cost of
exhausting capacity to benefit.

2.MAXIMISING PRINCIPLES
–Maximise health
–Maximise well-being (including non-
health aspects)

3.EGALITARAN PRINCIPLE
–Equalise lifetime health expectancy
(fair innings argument)
–Equalise opportunity for lifetime health
expectancy

THE COMBINED PACKAGE 1.What core treatments should be

provided

Three 3 main ways of approaching the 2.Which patients come first

establishment of a combined package.
3.What rights do patients have to
treatment
• Quality Adjusted Life Years

•QALY stands for Quality Adjusted Life Year.

"The essence of a QALY is that it takes a year of healthy life expectancy to be worth 1, but
regards a year of unhealthy life expectancy as worth less than 1.
Its precise value is lower the worse the quality of life of the unhealthy person (which is what
the 'quality adjusted' bit is all about)."
TYPE OF QALYs

•Macroallocation (QALYs, NICE)

–Balancing competing rights and duties with cost and outcome measures at
aggregate level
•Microallocation
–Balancing competing rights and duties with cost and outcome measures at
individual level