Making Medical Spending Decisions
The Law, Ethics, and Economics of Rationing Mechanisms
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Product details:
- Publisher OUP USA
- Date of Publication 1 May 1997
- ISBN 9780195092196
- Binding Hardback
- No. of pages312 pages
- Size 241x162x28 mm
- Weight 670 g
- Language English 0
Categories
Short description:
This is a fresh and comprehensive exploration of how health care rationing decisions are made. The author compares patients paying out of pocket, centralized authorities setting limits on what doctors can do and what insurance will pay, and motivating physicians to make these decisions at the bedside. His analysis of the political economics, ethics, and legality of each of these social mechanisms for making medical spending decisions reveals that none is uniformly superior, each is better suited for certain decisions than others and so a mix of all three is inevitable.
MoreLong description:
One of the most fundamental issues in health care delivery is who should decide which items of medical care are not worth their cost. This book is a fresh and comprehensive exploration of how health care rationing decisions are made. Unlike prior works, its focus is not on the specific criteria for rationing, like age or quality of life. Instead, the author provides comparative analysis of alternative social mechanisms for making medical spending decisions: (1) consumers paying for their medical treatment out of pocket; (2) payers, government officials, or other centralized authorities setting limits on what doctors can do and what insurance will pay for; and (3) physicians motivated to make these decisions at the bedside level. His analysis of each of these mechanisms reveals that none is uniformly superior, and each is better suited for certain decisions that others. Therefore, a mix of all three is inevitable.
The author develops his analysis along three dimensions: political economics, ethics, and law. The political economic dimension discusses the practical and theoretical aspects of each method for making spending decisions, synthesizing empirical studies of the situations in which each mechanism has been tested. The ethical dimension is based on several strands of philosophical theory, principally classic liberalism, social contract theory, and communitarianism, as well as conceptual analysis of terms such as autonomy and coercion. The legal dimension addresses recent developments in legal doctrine such as informed consent, insurance coverage disputes, and the emerging direction of federal regulation. Hall concludes that physician rationing at the bedside is far more promising than medical ethicists and the medical profession have traditionally allowed. The best way to allocate authority for making medical spending decisions in both public and private systems, he believes, is the informed purchase of different types of health insurance in a managed competition framework.
Table of Contents:
I. Introduction: Who Decides?
The Inevitability of Medical Spending Decisions
Asking the Right Questions
The Plan of this Book
II. Patient Spending Decisions
The Case in Favor of Market Reforms
Increasing Patient Sensitivity to Medical Costs
The Case Against Patient Cost Sharing
Conclusion
III. Third-Party Rules
Bureaucratic and Legalistic Mechanisms
Technocratic Resource Allocation and the Emerging Role of Science
The Flaws of Rule-Based Rationing
Ideal Democratic Processes
Physician Overseers
IV. Physician Bedside Discretion
Opposition to Physician Bedside Rationing
The Nature and Extent of Bedside Rationing
The Moral and Political Status of Mainstream Medical Ethics
Beneficence and Autonomy
Conclusion and Further Inquiries
Appendix
V. Motivating Physicians With Financial Incentives
Fiduciary Law
Agency Cost Theory
VI. Informed Consent to Rationing
Disclosing Rationing Mechanisms During Insurance Enrollment
Disclosure at the Time of Treatment
A Theory of Economic Informed Consent
Conclusion
VII. Conclusion: Deciding Who Decides
Comparing Decision Makers
Choosing Decision Makers
The Political Morality of Insurance Selection
Bibliography
Index
Making Medical Spending Decisions: The Law, Ethics, and Economics of Rationing Mechanisms
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