An inquiry into the principles of needs-based allocation of health care

Bioethics

Volumn 24, Issue 9, 2010, Pages 470-480

  Hope, Tony ^a   Østerdal, Lars Peter ^b   Hasman, Andreas ^c  

^a UNIVERSITY OF OXFORD   (United Kingdom)

^b UNIVERSITY OF COPENHAGEN   (Denmark)

^c Royal Pharmaceutical Society of   (United Kingdom)

Author keywords

Cost effectiveness; Distributive justice; Healthcare need; Non welfarist approaches; Resource allocation; Rule of rescue

Indexed keywords

ARTICLE; COST BENEFIT ANALYSIS; ECONOMICS; ETHICS; HEALTH CARE ORGANIZATION; HEALTH CARE PLANNING; HUMAN; NEEDS ASSESSMENT; NOMENCLATURE; SOCIAL JUSTICE; THEORETICAL MODEL; UNCERTAINTY;

COST-BENEFIT ANALYSIS; ETHICAL ANALYSIS; HEALTH CARE RATIONING; HEALTH PRIORITIES; HUMANS; MODELS, THEORETICAL; NEEDS ASSESSMENT; SOCIAL JUSTICE; TERMINOLOGY AS TOPIC; UNCERTAINTY;

EID: 77957884440     PISSN: 02699702     EISSN: 14678519     Source Type: Journal    
DOI: 10.1111/j.1467-8519.2009.01734.x     Document Type: Article

References (39)

1. N. Daniels & J. Sabin. Limits to Health Care: Fair Procedures, Democratic Deliberation and the Legitimacy Problem for Insurers. Philos Public Aff 1997; 26: 303-350.
2. National Institute for Health and Clinical Excellence. 2005. A Guide to NICE;
3. T. Hope et al. Rationing and the Health Authority. Br Med J 1998; 317: 1067-1069;
4. S. Griffiths, J. Reynolds & T. Hope. 2000. Priority Setting in Practice. In: The Global Challenge of Health Care Rationing. A. Coulter & C. Ham, eds. Buckingham: Open University Press: 203-213; D.K. Martin & P.A. Singer. 2000. Priority Setting and Health Technology Assessment: Beyond Evidence-Based Medicine and Cost-Effectiveness Analysis. In The Global Challenge of Health Care Rationing. A. Coulter & C. Ham, eds. Buckingham: Open University Press: 135-145;
5. D. Martin, J. Abelson & P. Singer. Participation in Health Care Priority-Setting through the Eyes of the Participants. J Health Serv Res Policy 2002; 7: 222-229.
6. E.g., Daniels & Sabin, op. cit. note 1; J. Harris. It is not NICE to discriminate. J Med Ethics 2005; 31: 373-375
7. See, for example, J. O'Neill. 2005. Need, Humiliation and Independence. In The Philosophy of Need. S. Reader, ed. Cambridge, UK: Cambridge University Press: 73-97.
8. See, for example, M.R. Gold et al., eds. 1996. Cost-effectiveness in health and medicine. New York: Oxford University Press; and M. Drummond et al. 2005. Methods for the Economic Evaluation of Health Care Programmes, 3rd edn. Oxford: Oxford University Press.
9. T. Hope et al. Rationing and the Health Authority. Br Med J 1998; 317: 1067-1069.
10. A.J. Culyer. Need: The Idea Won't Do - But We Still Need It. Soc Sci Med 1995; 40: 727-730) and Claxton and Culyer's insistence that one cannot avoid the ethical requirement to make decisions
11. K. Claxton & A. Culyer. Rights, responsibilities and NICE: a rejoinder to Harris. J Med Ethics 2007; 33: 462-464
12. D. Wiggins. 2005. An Idea We Cannot Do Without. In The Philosophy of Need. S. Reader, ed. Cambridge, UK: Cambridge University Press: 25-50, p. 40).
13. D. Wiggins. 1987. Claims of Need. In Needs, Values, Truth. 3rd edn. 1998. Oxford: Oxford University Press, 16: 1-57.
14. L. Doyal & I. Gough. 1991. A Theory of Human Need. London: Palgrave-Macmillan: 69-75.
15. E.g. C. Rowe. 2005. Needs and Ethics in Ancient Philosophy. In The Philosophy of Need. S. Reader, ed. Cambridge, UK: Cambridge University Press: 99-112.
16. E.g. G. Thomson. 2005. Fundamental Needs. In The Philosophy of Need. S Reader, ed. Cambridge, UK: Cambridge University Press: 175-186.
17. Doyal & Gough, op. cit. note 10. p. 50.
18. G. Brock. 2005. Needs and Global Justice. In The Philosophy of Need. S. Reader, ed. Cambridge, UK: Cambridge University Press: 51-72.
19. A. Hasman, T. Hope & L.P. Østerdal. Health Care Need: Three Interpretations. J Appl Philos 2006; 23: 145-156.
20. E.g., J. Harris. QALYfying the value of life, J Med Ethics 1987; 13: 117-123;
21. J. Harris. 1988. More and Better Justice. In Philosophy and Medical Welfare. J.M. Bell & S. Mendus, eds. Cambridge, UK: Cambridge University Press. See also B. Williams. 1962. The Idea of Equality. In Philosophy, Politics and Society. P. Laslett & W.G: Runciman, eds. Oxford: Basil Blackwell.
22. E.g. N. Daniels. Health Care Needs and Distributive Justice. Philos Public Aff 1981; 10: 146-179;
23. N. Daniels. 1985. Just Health Care. New York: Cambridge University Press; J. Rawls. 1993. Political Liberalism. New York: Columbia University Press.
24. See Culyer, op. cit. note 7. 'Capacity to benefit' appears to be the total gain in health state that is possible for a patient given unlimited resources. It is unclear to us whether Culyer considers it as a possible meaning for need or an alternative to it. In a recent paper (A.J. Culyer. Equity of What in Healthcare? Why the Traditional Answers Don't Help Policy - and What to Do in the Future. Healthc Pap 2008; 8, special issue: 12-26) Culyer suggests that capacity to benefit is similar to Sen's concept of 'capabilities' which is perhaps a type of normal functioning range theory of need.
25. In this context the issue of 'clinical need' was chosen as the focus of the first meeting of the NICE Citizen's Council, November 2002. Available at, [Accessed 20 Jul 07 http://www.nice.org.uk/page.aspx?o=45729].
26. See, e.g. http://www.shef.ac.uk/scharr/ir/nnt.html for a bibliography.
27. E.g. J. Harris. 1985. The Value of Life. Routledge: London.
28. A more thorough account of these approaches is given in Hasman et al. op. cit. note 27.
29. E.g. D.C. Hadorn. Setting Health Care Priorities in Oregon. JAMA 1991; 265: 2218-2225;
30. T. Hope. Rationing and Life-saving Treatment: Should Identifiable Patients Have Higher Priority? J Med Ethics 2001; 27: 179-185;
31. M. Sheehan. Resources and the Rule of Rescue. J Appl Philos 2007; 24: 352-366.
32. Decisions by the National Institute of Health and Clinical Excellence (NICE), op. cit. note 37, and by some local decision-making processes make use of such thresholds (see T. Hope T, J. Reynolds & S. Griffiths. 2002. Rationing Decisions: Integrating Cost-Effectiveness with Other Values. In Medicine and Social Justice. R. Rhodes, M.P. Battin & A. Silvers, eds. New York: Cambridge University Press.
33. For a general discussion, see, e.g. M. Drummond et al. 2005. Methods for the Economic Evaluation of Health Care Programmes. 3rd edn. Oxford: Oxford University Press.
34. A. Lazaro. Theoretical Arguments for the Discounting of Health Consequences - Where do we Go from Here? Pharmacoeconomics 2002; 20: 943-961;
35. M. Ortendahl & J.F. Fries. Time-related Issues with Application to Health Gains and Losses, J Clin Epidemiol 2002; 55: 843-448.
36. E.g. R.H. Thaler. 1994. The Winner's Curse. Princeton, NJ: Princeton University Press.
37. R. Cookson & P. Dolan. Public Views on Health Care Rationing: a Group Discussion Study. Health Policy 1999; 49: 63-74.
38. See, e.g. M. Lockwood. 1988. Quality of life and Resource Allocation. In Philosophy and Medical Welfare. J.M. Bell & S. Mendus, eds. Cambridge, UK: Cambridge University Press
39. A.Williams. Intergenerational Equity: an Exploration of the 'Fair Innings' Argument. Health Econ 1997; 6: 117-132.