Fair Resource Allocation and Rationing at the Bedside

by Marion Danis, Samia A. Hurst, Len Fleck, Reidun Forde, Anne Slowther

Overview

Health systems need to set priorities fairly. In one way or another, part of this important task will fall to physicians. How do they make judgments about resource stewardship, and how should they do so? How can they make such decisions in a manner that is compatible with their clinical duties to patients? In this book, philosophers, bioethicists, physicians, lawyers and health policy experts make the case that priority setting and rationing contribute significantly to the possibility of affordable and fair healthcare and that clinicians play an indispensable role in that process. The book depicts the results of a survey of European physicians about their experiences with rationing and other cost containment strategies, and their perception of scarcity and fairness in their health care systems. Responding to and complementing these findings, commentators discuss why resource allocation and bedside rationing is necessary and justifiable. The book explores how bedside rationing relates to clinical judgments about medical necessity and medical indications, marginal benefits, weak evidence based medicine, off-label use. The book highlights how comparative studies of health care systems can advance more effective and fair bedside rationing through learning from one another. From a practical standpoint, the book offers a number of strategies for health care systems and clinicians to work in tandem to allocate and ration resources as fairly as possible: how to foster more attention to fairness when rationing at the bedside, how to avoid exacerbating health disparities when allocating resources, how to teach about bedside rationing to students, how to discuss rationing more explicitly in the public arena and in the doctor's office.

Product Details

ISBN-13:	9780199989447
Publisher:	Oxford University Press
Publication date:	10/30/2014
Pages:	480
Product dimensions:	6.20(w) x 9.30(h) x 1.70(d)

About the Author

Marion Danis is Head of the Section on Ethics and Health Policy in the Department of Bioethics in the Clinical Center of the National Institutes of Health and Chief of the Bioethics Consultation Service at the Clinical Center. Her research focuses predominantly on improving the health of disadvantaged populations and on strategies for public engagement in priority setting. She is also serves as a general internist in a primary care clinic Montgomery County, Maryland.

Samia A. Hurst is professor of Bioethics and ethics consultant at Geneva University's medical school in Switzerland, chief editor of the Swiss bioethics journal Bioethica Forum, and a member of Switzerland's National Ethics Advisory Commission on Biomedical Ethics. Her research focuses on fairness in clinical practice, and the protection of vulnerable persons.

Leonard Fleck, Ph.D. is a Professor of Philosophy and Medical Ethics in the Center for Ethics and Humanities in the Life Sciences, College of Human Medicine, Michigan State University. His areas of research include social and political philosophy, theories of health care justice, health care rationing, democratic deliberation, ethical and policy issues related to genetics.

Reidun Førde is an MD and a previous Chair of the Council for Medical Ethics , Norwegian Medical Association. She was member of the second governmental commission on health priority making in Norway, and is also a member of the recently appointed third priority commission. She was also member of the first National Health Priority Council. Her research is on clinical ethics, end of life issues and resource allocation issues.

Anne Slowther is Associate Professor of Clinical Ethics at Warwick Medical School, UK, an ethics consultant at the University Hospital Coventry and Warwickshire NHS Trust, and a family physician. She is chair of the UK Clinical Ethics Network and a member of the Governing Body of the Institute of Medical Ethics. Her research interests are in ethical decision making in clinical practice and evaluation of clinical ethics support.

Table of Contents

Introduction
Marion Danis, Reidun Forde, Leonard M. Fleck, Samia A. Hurst, Anne Slowther

Part I. A European Survey of Bedside Rationing

Chapter 1. The Values at the Bedside Study: Bedside rationing by physicians
Samia A. Hurst, Anne Slowther, Reidun Forde, and Marion Danis

Chapter 2. The interaction of bedside rationing and the fairness of healthcare systems: Physicians' views
Samia A. Hurst, Reidun Forde, Anne Slowther, and Marion Danis

Part II The Societal Context

Chapter 3. The Swiss Context.
Samia A. Hurst

Chapter 4. The UK Context.
Anne Slowther

Chapter 5. The Norwegian Context.
Reidun Forde

Chapter 6. The Italian Context
Renzo Pegoraro and Alessandra Bernardi

Part III Analysis of Bedside Rationing

Chapter 7. How Do Economic Incentive Schemes Influence Rationing Decisions by Primary Care Physicians?
Tommy Allen, Matt Sutton, and Richard Cookson

Chapter 8. The legal context of bedside rationing.
Keith Syrett

Chapter 9. Bedside Rationing or Rational Planning: In Search of Perspective on Medical Benefit and Safety
Michael Barilan

Chapter 10. Just Caring: The Ethics Challenges of Bedside Rationing
Leonard M. Fleck

Chapter 11. Overdiagnosis and Overtreatment: Implications for Bedside Rationing
Howard Brody

Chapter 12. How can bedside rationing be justified despite coexisting inefficiency? The need for "benchmarks of efficiency"
Daniel Strech and Marion Danis

Chapter 13. The Collective Action Problem
Bob Goodin

Chapter 14. Statistical vs. Identifiable Lives: Why Not to Use the R Word.
Paul Menzel

Chapter 15. Give to The Doctor What is Due to The Doctor! Why 'Fair Rationing at The Bedside' is Impossible
Vegard Bruun Wyller


Part IV. Strategies for Promoting Fair Bedside Rationing

Chapter 16. Priority Setting in Hospital Care: Implementing National Legislation and Guidelines in a Hospital Trust
Odd Søreide, Stener Kvinnsland, and Torhild Heggestad

Chapter 17. Rationing by Clinical Judgment
Samia A. Hurst and Marion Danis

Chapter 18. Fairness and Transparency in Bedside Micro-allocation: Improving the Ethical Competence of Clinical Staff
Jan Schürmann, Barbara Meyer-Zehnder, Marcel Mertz, Heidi Albisser Schleger, Mathias Schlögl, Reto Kressig, Hans Pargger, and Stella Reiter-Theil

Chapter 19. Fair Resource Allocation in Clinical Care for Socially Disadvantaged Groups and Health Disparity Populations: Issues and Strategies
Irene Dankwa-Mullan, Paula Goodwin, and Matthew Wynia

Chapter 20. Bedside Rationing After Health Care Reform in the United States: The Emergence of Accountable Care Organizations
Steven D. Pearson

Chapter 21. Priority Setting Through Clinical Practice Guidelines: Lessons Learned
Ole Norheim

Chapter 22. Physicians as Bellwethers.
Susan Dorr Goold

Chapter 23. Moving Away from Silent Trepidation: Changing the Discussion of Rationing and Resource Allocation
Marion Danis, Greer Donley and Reidun Forde

Chapter 24. Priority Setting As a Clinical Skill: How Do We Educate Physicians?
Anne Slowther and Benjamin P Bennett

Afterword

Editorial Reviews

Reviewer: Tyler Zahrli, MA (Saint Louis University)
Description: This is an introduction to practical healthcare rationing in countries throughout Europe, a technique used to decrease medical expenditure and patient overconsumption.
Purpose: The purpose is to show the importance of rationing healthcare from multiple different perspectives and provide strategies to effectively implement such procedures in medical practice. The book describes the status quo of rationing healthcare in the European context, analyzes the positive and negative aspects of rationing, and provides examples of effective rationing.
Audience: It is intended primarily for physicians, hospital administrators, policymakers, and scholars in Western Europe. This book is useful for individuals with a stake in modern healthcare systems and their efficacy. The editor and authors are informed and credible sources.
Features: The book begins with an introduction to the importance of rationing healthcare services. The main body of the book is divided into four parts that a discussion of European opinion about rationing medical services, a contextual description country-by-country, an analysis of healthcare rationing, and clinical strategies to ration these services. Throughout the book, many different studies, graphs, and examples are referenced to further the argument for healthcare rationing. The book has a unique Western European perspective. A few shortcomings include a few typos, wordy language, and unnecessary information.
Assessment: This is a fairly useful book for understanding the importance of healthcare rationing for governments, physicians, and patients. The structure facilitates the argument well, but other books are more universally applicable and avoid extraneous information.

Doody's Review Service

"This is a fairly useful book for understanding the importance of healthcare rationing for governments, physicians, and patients." — Tyler Zahrli, Doody's

From the Publisher