© 2008 delmar cengage learning. chapter 1 values in health policy: understanding fairness and...
TRANSCRIPT
© 2008 Delmar Cengage Learning.
Chapter 1
Values in Health Policy:Understanding Fairness and
EfficiencyDeborah Stone
© 2008 Delmar Cengage Learning.
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Values in Health Care: Fairness and Efficiency
• Broad agreement on desirability of both values in principle– But difficult, if not impossible, to achieve
consensus on realizing both
• “Inherent tension” between the two
• Multiple definitions of both– Depending on one’s perspective
© 2008 Delmar Cengage Learning.
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Efficiency Defined
• Most simply, efficiency can be conceived as a bargain– With the ideal of achieving the highest ratio of
outputs to input
• Myth: efficiency can be measured – Efficiency can only be properly defined in
reference to an individual, party, or constituency
© 2008 Delmar Cengage Learning.
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Efficiency in Practice
• “The Waiting Room Game”– Efficiency from doctor’s point of view
• Always having patient available to treat, thus filling waiting room
– Does not factor in wasted time on the part of patients – One person’s efficient outcome represents another’s
wasted time/resources
© 2008 Delmar Cengage Learning.
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Contesting Fairness: Actuarial Fairness vs. the Solidarity Principle
• Actuarial fairness stressed by certain insurers beginning in 1980s– Tied cost of insurance premium to an
individual’s risk– Rhetorically asking why one should be forced
to finance another’s risks
© 2008 Delmar Cengage Learning.
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Contesting Fairness: Actuarial Fairness vs. the Solidarity Principle
• Solidarity principle/ideal more closely approximated in European systems– Society at large funds the care of the sick and
those (otherwise) least able to finance care
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Actuarial Fairness in Practice• Insurers first sought to exclude racial
minorities for their “greater risk”
• Despite laws seeking to reform such practices:– Minorities in some areas, as well as those
suffering from certain diseases, find themselves unable to receive coverage
© 2008 Delmar Cengage Learning.
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Actuarial Fairness in Practice
• Many insurers continue to perfect ways to further fragment market– Closely matching premiums to level of risk
• While excluding certain groups altogether
© 2008 Delmar Cengage Learning.
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The SolidarityPrinciple in Practice
• Seeks to accomplish the ideal of basing distribution of medical care on the basis of need– Not ability to pay
• Assumes that the community should be responsible for the cost of care for the infirm
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The SolidarityPrinciple in Practice
• Represents subsidy from the vast majority to the minority– Underlying principle of social insurance
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Efficiency and Fairness in the American Health Care System
• Current system infused with the spirit of actuarial fairness– Difficult to overcome
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Efficiency and Fairness in the American Health Care System
• Neither efficiency, nor fairness are “neutral criteria” through which to judge quality of health care system– They are values that have different meanings
to different people
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Efficiency and Fairness in the American Health Care System
• There will always be winners and losers in nearly any health care system
© 2008 Delmar Cengage Learning.
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Chapter 1 Summary
• Fairness and efficiency – Two values crucial to any health policy debate
• Idea of efficiency requires one to define specific perspective
© 2008 Delmar Cengage Learning.
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Chapter 1 Summary
• Central to the idea of fairness– Tension between actuarial fairness and the
solidarity principle
• Contemporary health care system tends to favor actuarial fairness over solidarity