Pricing Life: Why It's Time for Health Care Rationing

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Although managed health care is a hot topic, too few discussions focus on health care rationing—who lives and who dies, death versus dollars. In this book physician and bioethicist Peter A. Ubel argues that physicians, health insurance companies, managed care organizations, and governments need to consider the cost-effectiveness of many new health care technologies. In particular, they need to think about how best to ration health care. Ubel believes that standard medical training should provide physicians with the expertise to decide when to withhold health care from patients. He discusses the moral questions raised by this position,and by health care rationing in general. He incorporates ethical arguments about the appropriate role of cost-effectiveness analysis in health care rationing, empirical research about how the general public wants to ration care, and clinical insights based on his practice of general internal medicine. Straddling the fields of ethics,economics, research psychology, and clinical medicine, he moves the debate forward from whether to ration to how to ration. The discussion is enlivened by actual case studies.

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Editorial Reviews

From the Publisher
"The style of writing is personal (first person), conversational,anecdotal, self-deprecatingly disarming, gently persuasive, and often very amusing." Alan Williams Health Economy
Library Journal
Ubel (medicine and bioethics, Univ. of Pennsylvania) presents an overview of the moral and methodological conundrums raised by cost-effectiveness analysis (CEA), especially with regard to its role as a guide for how to ration healthcare. Ubel hopes that by viewing health rationing through the CEA lens, politicians, the public, and healthcare providers will be forced to open a debate on which services ought to be offered to everyone regardless of ability to pay and which should be offered according to ability to pay. Managed care, the political, stalemate surrounding healthcare delivery, and economic realities combine to make CEA a reasonable approach to healthcare rationing. Ubel is a persuasive advocate or CEA, seeing it as a powerful tool to help society set its healthcare delivery priorities. Recommended for bioethics and larger health collections.-James Swanton, Harlem Hosp. Lib., New York
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Product Details

  • ISBN-13: 9780262710091
  • Publisher: MIT Press
  • Publication date: 10/1/2001
  • Series: Basic Bioethics
  • Edition description: Reprint
  • Pages: 264
  • Product dimensions: 6.00 (w) x 9.00 (h) x 0.50 (d)

Meet the Author

Peter A. Ubel is Associate Professor in the Internal Medicine Department and Director of the Program for Improving Health Care Decisions at the University of Michigan Medical School. He is also staff physician at the Ann Arbor Veterans Affairs Medical Center.

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Table of Contents

Series Foreword ix
Acknowledgments xi
Introduction xiii
I Cost-Effectiveness and the Controversial Necessity of Health Care Rationing 1
1 Rationing According to Cost-Effectiveness: Explicit, Quantifiable, and Unacceptable? 3
2 The Politics of Defining Health Care Rationing 11
3 The Necessity of Rationing Health Care 31
4 The Challenge of Measuring Community Values in Ways Appropriate for Making Rationing Decisions 47
5 How Do People Want to Ration Health Care? Balancing Cost-Effectiveness and Fairness 67
II Cost-Effectiveness and Bedside Rationing: Do Two Wrongs Make a Right? 97
6 The Case Against Bedside Rationing 99
7 Recognizing Bedside Rationing 111
8 Linguistic Confusion about Bedside Rationing 125
9 The Unbearable Rightness of Bedside Rationing 137
III The Future of Cost-Effectiveness Analysis and Health Care Rationing 153
10 Future Possibilities for Improving How Cost-Effectiveness Analysis Incorporates Public Rationing Preferences 155
11 The Future of Cost-Effectiveness Analysis and Health Care Rationing 173
References 185
Index 199
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