This paper offers some comments on bioethical debates about resource allocation in healthcare. It is stimulated by Rosalind McDougall’s argument that it is an affront to the human dignity of people with below “liberties-level” health to fund human reproductive cloning. McDougall is right to underline the relevance of resource prioritisation to the ethics of research and provision of new biomedical technologies. This paper argues that bioethicists should be careful when offering comments about such issues. In particular, it emphasises the need (...) to represent accurately the reality of the situation—especially when we are passing judgement on technologies that are in their infancy and whose practical application is yet to be confirmed. The paper also emphasises the importance of the actual context to bioethical debate, and note that it would be better to talk about resource expenditure rather than resource allocation when it comes to discussing the rights and wrongs of how money is spent. It also reiterates the claims made by other writers that social and political philosophy need to have a transparent and considered role in debates about resources. (shrink)

Some argue that the concept of medical need is inadequate to inform the design of a universal health care system—particularly an institutional rather than a residual system. They argue that the concept contradicts the idea of comprehensiveness; leads to unsustainable expenditures; is too indeterminate for policy; and supports only a prioritarian distribution. I argue that ‘comprehensive’ understood as ‘including the full continuum of care’ and ‘medically necessary’ understood as ‘prioritized by medical criteria’ are not contradictory, and that UHC (...) is a solution to the problem of sustainability, not its cause. Those who criticize ‘medical need’ for indeterminacy are not transparent about the source of their commitment to their standards of determinacy: they promote standards that are higher than is necessary for legitimate policy, ignoring opportunity costs. Furthermore, the indeterminacy of concepts affects all risk-sharing systems and all systems that rely on medical standard of care. I then argue that the concept of need in itself does not imply a minimal sufficientist standard or a prioritarian distribution; neither does the idea of legitimate public policy dictate that public services be minimalist. The policy choice for a system of health care that is comprehensive and offers as good care as can be achieved when delivered on equal terms and conditions for all is a coherent option. (shrink)

Many academic medical centers are seeking to attract patients from outside their historical catchment areas for economic and programmatic reasons, and patients are traveling for treatment that is unavailable, of poorer quality, or more expensive at home. Treatment of these patients raises a number of ethical issues including whether they may be given priority in scheduling outpatient follow-up appointments in order to reduce the period of time they are away from home. Granting them priority is potentially unjust because (...) class='Hi'>medical treatment is generally allocated based on medical need and resource utilization, and then on a first-come, first-served basis. While it is difficult to compare the opportunity cost of waiting for an appointment to different patients, nonresident patients incur higher expenditures for travel, room, and board than resident patients. Giving them priority in scheduling to reduce these costs may be justifiable. Preferentially scheduling nonresident patients may also indirectly benefit resident patients consistent with Rawls’s difference principle. This potential justification, however, rests on several empirical claims that should be demonstrated. In addition to reducing resident patients’ waiting times, medical centers should not prioritize nonresident patients over resident patients with more urgent medical needs. There is, therefore, a limited and circumscribed justification for prioritizing nonresident patients in scheduling follow-up appointments. (shrink)

Two contributions from Dr Ivan Illich follow. The first, in which he sets out his primary thesis of the medicalization of life, is a section from Dr Illich's book `Medical Nemesis'. (It is reprinted with the permission of the author and his publishers, Messrs Calder and Boyars.) The second is a transcript of the paper which Dr Illich read at the conference organized by the London Medical Group on iatrogenic disease. Both are ultimately addressed to the recipients of (...) medical care, the general public, although the second paper is specifically addressed to young doctors and medical students. For Dr Illich the world is suffering from too much medical interference, and a medical edifice has been built which is one of the threats to the real life of human beings - a threat which so far has been disguised as care. (shrink)

The issue of assessing priorities is one that has become the subject of much debate in the National Health Service particularly in the wake of various documents on priorities from central Government. It has become even more so with the prospect of real cuts in expenditure. Economists claim that their science, or perhaps more accurately art can assist in determining not only how best to achieve various ends but also whether and to what extent competing objectives should be pursued. (...) Such choices cannot be made in the absence of some ethical considerations and it is important that health service decision makers (and in particular the medical profession) are aware if the relationship between economics (and especially cost-benefit analysis) and medical ethics. (shrink)

Arising from four conferences held in Europe and the United States, this volume contains eighteen essays written mostly by Roman Catholics with the exception of select contributions from Jewish, Protestant, and Orthodox perspectives. Most essays pay particular attention to the distribution of scarce medical resources in terms of intensive care units (ICUs) which use some 38% of all medical expenditures in the U.S. each year, one percent of the GNP. The essays often make reference to one another and (...) a wide variety of Catholic perspectives are represented. The essays offer a good reflection of the contemporary state of Catholic moral thought with its strengths and diversity and are nicely framed by the ‘outside voices’ of the non-Catholics represented. Philosophers will find some essays almost exclusively theological. (shrink)

The general consensus is that reform of medical malpractice law should be part of the health care system's overhaul. Medical malpractice litigation results in the expenditure of tens of billions annually, largely paid out of health care insurance funds and mostly paid to defendants' and plaintiffs' lawyers. By all accounts, this tort law regime ill serves the basic deterrence and compensation goals of civil liability. The causes and magnitude of these failings are disputed, and many typical reform (...) proposals sidestep the basic problems and may do more harm than good. In contrast, we advance a straightforward way to improve both deterrence and compensation. Essentially, the proposal is to remove current legal limitations on the scope of insurance subrogation that bar private and public health care insurers from “buying” the whole of their insureds' potential medical malpractice claims in exchange for lower premiums and taxes and expanded insurance coverage. Our proposal’s benefits accrue regardless of the cause and magnitude of the failings of malpractice law or the further reforms that might be adopted. (shrink)

In China, state investment into public hospitals has radically decreased since the early 1980s and has brought on the dismantling of the healthcare system in most parts of the country, especially in rural areas. As a result of this overhaul, the majority of public hospitals have needed to compete in the so-called socialist market economy. The market economy stimulated public hospitals to modernize, take on highly qualified medical professionals, and dispense new therapies and drugs. At same time, liberalization has (...) clearly affected the attitude and behavior of both medical professionals and the general public. The public has many concerns about the healthcare system for various reasons: there are long hospital waiting lists, patients experience difficulties in obtaining an appointment to see a qualified doctor, and, over the past decades, there has been an increase in out-of-pocket healthcare expenditure. These and other changes in post-reform China have radically reshaped the doctor–patient interaction, which is increasingly eroded by tension and violence. (shrink)

Following publication of the influential Flexner Report on medical education in 1910, the US built a health care system on a foundation of science that, by the end of the 20th century, provided some of the best medical care in the world. Now, at the start of the 21st century, we are in real danger of destroying those impressive achievements. The primary reason is the failure over many years to change our increasingly dysfunctional health insurance system. Chief among (...) its problems is reduced access to medical services as growing numbers of Americans lose health insurance altogether, and coverage for the rest is eroding. (shrink)

From 1919 to 1951, Alan Gregg and his mentor, Richard Pearce, directed the Medical Education and Medical SciencesDivisions of the Rockefeller Foundation. Although they oversaw the expenditure of millions of dollars, today they are forgotten. Yet, the system that Gregg administered became the model for the funding of biomedical research after the Second World War. This paper draws on the records of the Rockefeller Foundation to assess Gregg and his impact on biomedicine and philanthropy.

The recent focus on conflict of interest seriously misfires by fixating on monetary payoffs while ignoring all the other things that people care about, things that can bias their judgment and lead to wrongdoing. Wrongdoing should be the focus, not the temptations and motivations that sometimes result in it. This essay explores the evidence in support of strong regulations against conflict of interest, and I conclude that corruption fears have resulted in social-distancing policies of drug reps from physicians and they (...) have given us sharply constrained information markets. There is some evidence that this may be disadvantageous to patients. Information market restrictions do promote powerful political and corporate interests. Whether there are compensating benefits in reduced expenditures on drugs and devices remains to be seen. We can only hope that our institutional policies eventually will be revised in a manner that better respects physicians as sophisticated consumers of product marketing and holds them accountable for their choices not their motivational states. (shrink)

Healthcare systems in Singapore, Hong Kong, and mainland China are strikingly distinct from those in the West. Economically speaking, each of the aforementioned Eastern systems relies in great measure on private expenditures supplemented by savings accounts. Western nations, on the other hand, typically exhibit government funding and wariness about healthcare savings accounts. This essay argues that these and other differences between Pacific Rim healthcare systems and Western systems should be assessed in light of background Confucian commitments operating in the former. (...) In the Confucian context, bioethics and healthcare policy have a unique content, texture, and set of implications that often affront Western assumptions about the appropriate individual autonomy of patients and the appropriate character of social safety nets for healthcare. (shrink)

Using data from the Household Component of the Medical Expenditure Panel Survey (MEPS-HC), this Statistical Brief presents health insurance estimates for the Hispanic population by subgroups and U.S. citizenship status. An examination of these estimates reveals dramatic disparities in insurance coverage within the Hispanic population due to differences in eligibility for public programs and access to private coverage.

Many writers suggest that managed care had a brief life and that we are now in a post-managed care era. Yet managed care has had a long history and continues to thrive. Writers also often assume that managed care is a fixed entity, or focus on its tools, rather than the context in which it operates and the functions it performs. They overlook that managed care has evolved and neglect to examine the role that it plays in the health system.This (...) article argues that private actors and the state have used managed care tools to promote diverse goals. These include the following: increasing access to medical care; restricting physician entrepreneurialism; challenging professional control over the medical economy; curbing medical spending; managing medical practice and markets; furthering the growth of medical markets and private insurance; promoting for-profit medical facilities and insurers; earning bounties for reducing medical expenditures; and reducing governmental responsibility for, and oversight of, medical care. Struggles over these competing goals spurred the metamorphosis of managed care internationally. (shrink)

This paper presents an empirical analysis of the determinants of quantity of health insurance in the context of employer-based health insurance using the micro-level data from the 1987 National Medical Expenditure Survey (NMES). It extends the previous research by including additional factors in the analysis, which significantly affect health insurance offers by employers. This paper emphasizes two determinants of employers’ insurance offer decisions that are particularly relevant: union membership and selfinsured versus not self-insured health plans. The conducted empirical (...) analysis reported in this paper reveals the following predictors of higher health insurance coverage: union membership, not self-insured health plan(s), union membership in Midwest or South, as well as self-insured union membership. Further, other factors such as: age, male, income, for profit and other employer organizational forms, and firm’s size determine a higher level of health insurance. (shrink)

The conventional wisdom is that managed care's brief life is over and we are now in a post-managed care era. In fact, managed care has a long history and continues to thrive. Writers also often assume that managed care is a fixed thing. They overlook that managed care has evolved and neglect to examine the role that it plays in the health system. Furthermore, private actors and the state have used managed care tools to promote diverse goals. These include the (...) following: increasing access to medical care; restricting physician entrepreneurialism; challenging professional control over the medical economy; curbing medical spending; managing medical practice and markets; furthering the growth of medical markets and private insurance; promoting for-profit medical facilities and insurers; earning bounties for reducing medical expenditures: and reducing governmental responsibility for, and oversight of, medical care. Struggles over these competing goals spurred the metamorphosis of managed care. This article explores how managed care transformed physicians' conflicts of interests and responses to them. It also examines how managed care altered the opportunities for patients/medical consumers to use exit and voice to spur change. (shrink)

Workers in predominantly female occupations have, on average, lower wages compared to workers in predominantly male occupations. Compensating differentials theory suggests that these wage differences occur because women select into occupations with lower pay but more fringe benefits. Alternatively, devaluation theory suggests that these wage differences occur because work performed by women is not valued as highly as work performed by men. One theory assumes that workers choose between wages and benefits. The other assumes that workers face constraints that restrict (...) their wages and benefits. To examine whether female occupations pay less but offer more benefits, I used individual-level data from the Medical Expenditures Panel Survey and occupation-level data from the American Community Survey and from the Occupational Information Network. Contrary to compensating differentials theory, results from multivariate regression analysis provide little evidence that benefits explain wage differences between male and female occupations. Instead, consistent with devaluation theory, workers in female occupations are less likely to be offered employer health insurance coverage and are less likely to have retirement plans compared with workers in male occupations. (shrink)

Background: Expenditure on industry products (mostly drugs and devices) has spiraled over the last 15 years and accounts for substantial part of healthcare expenditure. The enormous financial interests involved in the development and marketing of drugs and devices may have given excessive power to these industries to influence medical research, policy, and practice.Material and methods: Review of the literature and analysis of the multiple pathways through which the industry has directly or indirectly infiltrated the broader healthcare systems. (...) We present the analysis of the industry influences at the following levels: (i) evidence base production, (ii) evidence synthesis, (iii) understanding of safety and harms issues, (iv) cost-effectiveness evaluation, (v) clinical practice guidelines formation, (vi) healthcare professional education, (vii) healthcare practice, (viii) healthcare consumer’s decisions.Results: We located abundance of consistent evidence demonstrating that the industry has created means to intervene in all steps of the processes that determine healthcare research, strategy, expenditure, practice and education. As a result of these interferences, the benefits of drugs and other products are often exaggerated and their potential harms are downplayed, and clinical guidelines, medical practice, and healthcare expenditure decisions are biased. Conclusion: To serve its interests, the industry masterfully influences evidence base production, evidence synthesis, understanding of harms issues, cost-effectiveness evaluations, clinical practice guidelines and Healthcare professional education and also exerts direct influences on professional decisions and health consumers. There is an urgent need for regulation and other action towards redefining the mission of medicine towards a more objective and patient-, population- and society-benefit direction that is free from conflict of interests. (shrink)

Healthcare expenditures account for approximately 9% of GDP in OECD countries and are on an upward trajectory (OECD, 2017). This significant financial burden, combined with an aging global population and increasing demand, emphasizes the imperative for sustained research and innovation to enhance health system efficacy. Key to this transformation are technological advancements, including digital health, which presents novel opportunities for improvement. Emerging digital health technologies, such as virtual consultations, complex imaging procedures, and electronic medical records, are fundamental to modern (...) healthcare infrastructures. However, significant gaps remain in the evaluation and understanding of these innovations, especially for nascent technological areas. This thesis addresses this subject, aiming to delineate how individuals and institutions can bolster their evaluative capabilities, strategic decision-making, and planning for the deployment of emerging digital healthcare technologies. The research methodology amalgamates theoretical exploration, literature scrutiny, and empirical examinations, presenting an integrated perspective that intersects the disciplines of Management & Decision Science, Technology & Innovation, and Health Economics & Outcomes Research. From an applied perspective, this research focuses on developing evidence within the context of pediatric healthcare in Canada — a context notably underrepresented in healthcare management research, despite its disproportionate per capita expenditure. Technologically, the predominant focus is on applications in virtual reality (VR) and three-dimensional (3D) printing and virtualization, though with the aspiration of ensuring the generalizability of results. The current thesis is structured to parallel the progression of the research itself, as three distinct phases; this begins with a comprehensive Background that contextualizes the initial intent, exploring the relationship between technology, innovation, and health outcomes. In this phase, each academic discipline is analyzed to identify base theoretical underpinnings for the research. The second phase of this work includes five empirical studies, each preceded by context-specific literature reviews for the respective technological domain, providing insight into the current state of evidence related to value-based assessment and economic evaluation in that area. Empirical studies included a randomized controlled trial and a cost consequences assessment of VR for pre-procedural preparation for medical imaging. Additionally, novel applications of 3D printing and virtualization are critically analyzed, accompanied by a multi-case study on the implementation of 3D printing in pediatrics, a cost-consequences study of applications for thoracoabdominal surgeries, and an outcomes study on the use of 3D virtualization in medical education during the COVID-19 pandemic. The final phase of this research includes the critical analysis and synthesis of findings into a proposal for a novel value-based assessment and decision-making framework specific to emerging health innovations; this framework integrates insights and resources for clinicians, administrators, and policymakers. The outcomes of this research are skewed toward Knowledge Users, but also aims to advance the theoretical basis for health technology assessment (HTA). (shrink)

The Pharmaceutical Benefits Scheme, operating in Australia under the National Health Act 1953, provides citizens equal access to subsidised pharmaceuticals. With ever-increasing costs of medicines and global financial pressure on all commodities, the sustainability of the PBS is of crucial importance on many social and political fronts. Direct-to-consumer advertising (DTCA) of prescription medicines is fast expanding, as pharmaceutical companies recognise and reinforce marketing potentials not only in healthcare professionals but also in consumers. DTCA is currently prohibited in Australia, but pharmaceutical (...) companies continuously lobby for the ban to be lifted. There is evidence that such marketing strategies influence consumer behaviour and concerns have been raised about whether DTCA could affect government expenditure on the PBS in Australia. This pharmacy-based study explored Australian consumer attitudes towards DTCA and whether consumer attitudes regarding DTCA differ based on socioeconomic status, measured in terms of income and education. Consumers from different socioeconomic areas in Sydney were asked to respond to a survey about an advertisement created specifically for the promotion of a mock prescription medicine. Their views about the intent, value and reliability of the advertisement were explored. The study found that consumers of lower socioeconomic status were more likely to perceive DTCA as a source of valuable and reliable medical information, and that they were more likely to request an advertised medication from their physician. If DTCA of prescription medicines was to be introduced in Australia, an increase in government expenditure on the PBS would be anticipated. Findings of this study also expose a deficit in respect for patients’ right to autonomy and informed consent which should be based on evidence-based, unbiased, information rather than advertisements. (shrink)

Despite growing advances in medical technologies, health status inequalities continue to increase across the globe. Developing countries have been faced with declining expenditures in health and social services, increasing burdens posed by both communicable and non-communicable diseases, and economic systems poorly geared to fostering sustainable development for the poorest and most marginalized. Under such circumstances, the challenges facing health practitioners in countries in transition are complex and diverse, and require the balancing of many conflicting imperatives. This is particularly so (...) in relation to the development of public health policy, where equity, redress of past inequalities, and the god of social justice may seemingly be pitted against macroeconomic adjustments required for national economic development in an increasingly globalized economic order.For example, pressures to deregulate as part of a market-oriented development philosophy will increase the risks from occupational hazards in populations desperate for paid employment. (shrink)

Despite growing advances in medical technologies, health status inequalities continue to increase across the globe. Developing countries have been faced with declining expenditures in health and social services, increasing burdens posed by both communicable and non-communicable diseases, and economic systems poorly geared to fostering sustainable development for the poorest and most marginalized. Under such circumstances, the challenges facing health practitioners in countries in transition are complex and diverse, and require the balancing of many conflicting imperatives. This is particularly so (...) in relation to the development of public health policy, where equity, redress of past inequalities, and the god of social justice may seemingly be pitted against macroeconomic adjustments required for national economic development in an increasingly globalized economic order.For example, pressures to deregulate as part of a market-oriented development philosophy will increase the risks from occupational hazards in populations desperate for paid employment. (shrink)

It is commonly believed thatgeriatric medicine generates a distinctive setof ethical problems. Implicated are such issuesas resource allocation, competence and consent,advance directives, medical futility anddeliberate death. It is also argued that itwould be unjust to allow the elderly to competewith younger populations for expensive andscarce health care resources because theelderly “have already lived,” and that treatingthem the same as these other populations woulddiminish the available resources unfairly,prolong a life of inevitably failing health andresult in increased health care expenditures.In fact, (...) however, this perception of ethicaluniqueness is mistaken. Differences in medicalconditions, demographics and aetiology shouldnot be allowed to obscure the fact that ethicalissues in geriatric medicine are essentiallythe same as those faced in any other area ofhealth care, and that the solutions that areadopted in the geriatric context must beconsistent with the ethical principles that arefollowed elsewhere. The paper argues that theroot of the mistaken perception lies in theabandonment of the Hippocratic mandate ofmedicine and in an unreflective adherence tothe belief that medical advances are inevitablybeneficial. It is suggested that a return topatient-centred medicine and the use of ethicsimpact analyses before introducing medicaladvances may be ethically appropriate. (shrink)

Health care in France falls almost exclusively under theresponsibility of the Social Security department, which coversalmost all the expenditures related to health care,whether hospitalization or medication is concerned.For severe diseases or surgery the coverage is likelyto reach as much as 100%. The medical expendituresfor several severe diseases, such as cancer, myocardialinfarction, or neurodegenerative diseases are 100% coveredfor a period of time as long as three months. For some procedures, full coverage may be achieved by usinga subscription to private health (...) care insurance.Access to cover by the state has recently been openedto anyone living in France, after passage of a special law. There is still a lack of intensive care and hospice beds, given the rapidly increasing number of elderly who cannot be maintainedat home. There is a tendency to reduce the number ofbeds in private and public hospitals due to thegreat number of such institutions and the generalconcern that a low volume of procedures, associatedwith inexperienced health care professionals, is likelyto increase morbidity and mortality as well as publichealth care expenditure. Patients are still free tochoose doctors and hospitals (whether privateor public), provided that beds are available and thatspecific procedures can be carried out in thevicinity. So far no waiting list is needed, exceptfor specific procedures performed by a few specialists of high repute. Health care expenses are increasingcontinuously, which results in a very expensive systemin France. (shrink)

Bribing doctors for preferential treatment is rampant in the healthcare system of developing countries like Vietnam. Although bribery raises the out-of-pocket expenditures of patients, it is so common to be deemed an “envelope culture.” Given the little understanding of the underlying mechanism of the culture, this study employed the mindsponge theory for reasoning the mental processes of both patients and doctors for why they embrace the “envelope culture” and used the Bayesian Mindsponge Framework (BMF) analytics to validate our reasoning. Analyzing (...) responses from 1042 Vietnamese patients, we discovered that bribing doctors can help patients reduce the destitution risk induced by treatment. Such effect of doctor bribery remains consistent among patients that have to pay high daily costs (e.g., accommodation and subsistence fees) regardless of their employment status. Nevertheless, for patients with no or unstable jobs, their risks of destitution increase if they have to pay more thank-you money. These findings suggest that doctor bribery is an adaptive strategy for patients in an environment where the healthcare supply cannot meet the actual demand. Moreover, healthcare equity is greatly exacerbated due to the envelope culture, as vulnerable individuals are exposed to a greater threat of poverty. At the same time, those with good economic conditions get preferential treatment by paying a higher amount of thank-you money. Healthcare workers’ ethics must be the top priority for an equitable and proper healthcare system. (shrink)

This paper addresses the question of whether Medicaid is in fact a high-cost program after adjusting for the health of the people it covers. We compare and simulate annual per capita medical spending for lower-income people (families with incomes under 200% of poverty) covered for a full year by either Medicaid or private insurance. We first show that low-income privately insured enrollees and Medicaid enrollees have very different socioeconomic and health characteristics. We then present simulated comparisons based on multivariate (...) statistical models that estimate the effects of private and Medicaid coverage on the likelihood of using services, and the level of expenditures, given any use, holding constant demographic, economic, and health status characteristics. The simulations demonstrate that if people with Medicaid coverage—with their health status, disability, and chronic conditions—were given private coverage, they would cost considerably more than they do today. Conversely, if the privately insured were given Medicaid coverage, spending would be lower. We find no evidence that spending differences between Medicaid and private coverage for low-income people are due to lower service use by Medicaid beneficiaries. We conclude that most of the difference in expenditures is due to differences in provider payment rates. (shrink)

The reality of current clinical practice in the UK is that where a patient’s family refuses to agree to testing for brain stem death (BD), such cases will ultimately end up in court. This situation is true of both adults and children and reinforced by recent legal cases. While recourse to the courts might be regrettable in such tragic cases, if public trust in the medical diagnosis of BD is to be maintained all aspects of the process must be (...) conducted in a way that is transparent and open to scrutiny. This is not an ‘ineffective expenditure’ of resources, but an essential element of a human rights-compliant legal system. (shrink)

In recent years, the government, advocacy organizations, the press, and the public have pressured universities, academic medical centers, and physicianinvestigators to do more to ensure that their financial interests and relationships do not conflict with their duties to conduct high-quality research and protect the safety and welfare of clinical trial participants. A number of factors underlie the increased focus. First, private sector funding of clinical research has grown both in absolute terms and as a proportion of overall funding. In (...) 2008, the pharmaceutical, medical device, and biotechnology industries’ domestic research and development expenditures constituted approximately 60.9% of funding for biomedical research in the United States; the next largest funder, the National Institutes of Health, funded 27.9%. Private industry spent $58.6 billion on research in 2007, up from $40 billion in 2003, an increase of 25% after adjusting for inflation. (shrink)

Cosmetic surgery is a fast-growing medical practice. In 1997 surgeons in the United States performed the four most common cosmetic procedures443,728 times, an increase of 150% over the comparable total for 1992. Estimated total expenditures for cosmetic surgery range from $1 to $2 billion. As managed care cuts into physicians' income and autonomy, cosmetic surgery, which is not covered by health insurance, offers a financially attractive medical specialty.

It is doubtful that any feature of the American health care system in the last several decades has had as profound an effect on the way Americans pursue their perceived health needs as complementary and alternative medicine. Almost half of all Americans take care of some of their health care needs outside of contemporary scientific medicine. The number of visits to CAM practitioners was estimated 6 years ago to be 629 million a year, with expenditures of $27 billion a year. (...) The use of CAM has been expanding rapidly despite little objective evidence of its safety or effectiveness. Little more than a decade ago CAM was viewed by the traditional medical community as a nuisance that offered unproven treatments at best and as outright quackery at worst. In any case, alternative medicine, as it was known at that time, seemed unworthy of serious attention. (shrink)

The Israeli health care system is looked upon by some people as one of the most advanced health care systems in the world in terms of access, quality, costs and coverage. The Israel health care system has four key components: (1) universal coverage; (2) ‘cradle to grave’ coverage; (3) coverage of both basic services and catastrophic care; and (4) coverage of medications. Patients pay a (relatively) small copayment to see specialists and to purchase medication; and, primary care is free. However, (...) during 2011 the Israeli Medical Association (IMA) spent 5 months on a strike, justifying it as trying to ‘save’ the Israeli public health. This paper describes some aspects of the Israeli Health Care System, the criteria for setting priorities for the expenditures on health care and values underlying these criteria. The paper observes that the new agreement between the IMA and the government has given timely priority to problematic areas of specialization (in which there is an acute shortage of physicians) and to hospitals in the periphery of the country. Yet weak points in the health system in Israel remain. Particularly, the extent to which national health care expenditures are being financed privately—which is rising—and the parallel decline in the role of government financing. (shrink)

Providing care for a baby born at 24 weeks of gestation in a neonatal intensive care unit is one of the most expensive medical treatments in the United States today. The cost can easily run over $300,000 for one baby. Furthermore, many extremely premature babies who survive are left with chronic diseases or disabilities that require further medical expenses and other specialized services throughout childhood or throughout life. When all these expenditures are totaled up, it can seem that (...) neonatal intensive care is just not worth it.Concerns about the cost-effectiveness of NICUs have led to persistent critical scrutiny of these specialized units by physicians, economists, and epidemiologists. These analysts have examined NICUs and the patients in them in order to determine whether there are subpopulations of babies for whom neonatal intensive care is so demonstrably ineffective or so costly that it should not be provided. Such examinations have been carried out in many different countries, at many times over the last 30 years, and have analyzed outcomes for babies by gestational age, birthweight, and illness severity. (shrink)

Over 1.3 billion people in the world are challenged to access good and cheap healthcare when become ill. Health insurance policies are a fantastic strategy to assist people who can't afford medical care. For middle- and low-income nations, there hasn't been much research on the ability to pay for health insurance for public employees like school teachers. Therefore, this cross-sectional questionnaire based research has been undertaken to explore the reflection of health insurance among 383 Bangladeshi school teachers of 5 (...) divisional city center primary school and were being surveyed online between 1st August to 30th August 2022. According to survey, monthly average (mean) health expenditure of respondents were 7668.93 BDT (Bangladeshi Taka equivalent to $80.72) with 95% confidence interval. Of 35% responders suffered from high blood pressure, approximately 8% people were suffering from arthritis and asthma, 7.8% people have heart disease and 8.1 % people suffer from cholesterol problem. Maximum respondents (80%) agreed that health insurance is burden for them. About 51% teachers had no idea about health insurance. However, there was no significant relation in between educational status and health insurance perception for male and female teacher respondents. Moreover, the comparative data highlighted that more awareness and more exploration might be needed in health insurance perception for primary school teachers. This result can contribute to form people’s choice-oriented health insurance policy. (shrink)

According to the Catholic Social Teaching, tax evasion is ethically reprehensible and people who do it commit sin. The Catholic Church based its opinion first of all on the Holy Scripture (the teaching of Jesus, St. Peter’s and St. Paul’s). Also pope John Paul II, primate of Poland Stefan cardinal Wyszyński and Joseph cardinal Höffner objected to tax frauds. The survey was conducted among the students of the University of Lodz and of the Medical University of Lodz. Its aim (...) was to examine the students’ opinion about tax evasion. The students’ answers were grouped with regard to church attendance in order to trace if there exists a correlation between church attendance and tax morality. Statistical analysis indicated a connection between church attendance and tax morality. The highest tax morality was noticed in the group of regularly practising Catholics, a bit smaller in the non-practising or unbelieving group of people and the least tax morality was noticed among the irregularly practising group of Catholics. According to the students’ opinion, the main reason to pay taxes is for fear of financial sanction. Among other reasons the respondents listed that it is a national duty or that it is necessary to cover national expenditures. It is optimistic, however, that most of the students declared to pay the taxes fairly, if they run their own corporations in the future. (shrink)

In Holding Health Care Accountable , E. Haavi Morreim differentiates between duties of expertise and resource duties, arguing for tort liability respecting the former and contract liability respecting the latter. Though Morreim's book addresses ordinary clinical medicine, her liability scheme may also be relevant elsewhere. Focusing on disaster medicine, and especially the medical management of violent mass disasters (e.g., where terrorists have deployed weapons of mass destruction), I argue in this essay that Morreim's classification of duties still fits, but (...) that it is difficult to hold government powers accountable for their many resource and expertise duties. This difficulty is compounded by political arrangements that foist under-funded mandates for disaster services on healthcare providers. As a result of such arrangements, hospitals and clinicians are prone to liability for expenditures and clinical interventions that are beyond their scope. This problem can be mitigated, I argue, by examining and clarifying the apparent social compact between society and healthcare. (shrink)

One of the most pressing issues that confronts the Food and Drug Administration (FDA) is learning how to better address and assist in medical product development. FDA needs to prepare today so the agency can efficiently evaluate the technologies of tomorrow. Clearly, this is an area that impacts not only health care consumers but also our economies and financial markets. If the FDA can be a more aggressive part of the solution, they can help not only ease some of (...) the pressures that are driving up health care costs but also help all of us to maximize the value of medical innovations. The high cost of research and development is forcing many companies to make the short-term business decision to focus product development on those molecules that have a much higher potential to recoup expenditures. Unfortunately, this trumps attempts to develop potentially risky but breakthrough products for diseases affecting smaller populations, the orphan drugs. FDA's critical path initiative will enable innovative growth companies to better and more efficiently attack the steep hurdles facing them, allowing them to compete more effectively against the bigger, better-funded players in the market on a more level playing field. That means a real change in the risk/benefit equation for both the emerging growth companies and the public health. (shrink)

Rehabilitation for disabled children requires long-term programmeswhich are expensive to the family. This study aimed to estimate the costincurred by caregivers’ children with disabilities from Pahang, Terengganu andKelantan participating in Community-Based Rehabilitation and cost of seeking alternative rehabilitation. Costanalysis using the Activity-Based Costing method was used to estimatetwelve-months’ expenditure in 2014 institutional year on 297 caregivers ofchildren with disability, aged 0 to 18 years who attended CBR. Data werecollected using a self-administered costing questionnaire and presentedin median. Results showed that (...) the median direct and indirect costs,excluding medications and alternative care were nearly four times as highin Home-Based compared to Centre-Based vs. RM608. Both groups of caregivers spent a significant amount ofresources on alternative rehabilitation. The high costs incurred for alternativerehabilitation is a major economic burden to the family. (shrink)

Mounting evidence documents the extraordinary toll on human health resulting from the consumption of unhealthy food products and physical inactivity. Diseases related to poor nutrition – such as diabetes, heart disease, stroke, and some cancers – are among the leading causes of disability and death in the United States. Poor diet and lack of exercise come second only to tobacco use in actual causes of preventable death in this country. It is estimated that 6% of all adult health care, 7% (...) of Medicare, and 11% of Medicaid expenditures are attributable to obesity. According to the Centers for Disease Control and Prevention, the direct medical cost associated with physical inactivity was nearly $76.6 billion in 2000.In response to America's growing obesity problem, local policymakers have been looking for legal strategies to adopt in their communities to encourage healthful behaviors. Taking the lead from the successful tobacco control movement, nutrition advocates are seeking strategies to “denormalize” unhealthy behaviors, rather than pursuing education-based approaches that encourage individuals to change their own personal behavior. (shrink)

If clinical trials become a commercial venture in which self-interest overrules public interest and desire overrules science, then the social contract which allows research on human subjects in return for medical advances is broken.BackgroundIn the past two decades, the involvement of non-academic sponsors of biomedical research, particularly clinical trial research, has increased exponentially. The value of such sponsored research is difficult to ascertain. However, it is estimated that, between 1980 and 2003, overall research and development expenditures by US pharmaceutical (...) companies increased from $2 billion to $33 billion and that, in 2001, clinical trial research expenditures in Canada totaled $800 million to $1 billion.The source of funding for biomedical research has shifted significantly from predominantly government and private foundations to industry. By 2002,70% of funding for clinical trials came from industry. These factors have affected the conduct of research, particularly clinical trial research, in a variety of ways. (shrink)

BackgroundDefensive medicine (DM) practice refers to the ordering or prescription of unnecessary treatments or tests while avoiding risky procedures for critically ill patients with the aim to alleviate the physician’s legal responsibility and preserve reputation. Although DM practice is recognized, its dimensions are still uncertain. The subject has been highly investigated in developed countries, but unfortunately, many developing countries are unable to investigate it properly. DM has many serious ramifications, exemplified by the increase in treatment costs for patients and health (...) systems, patients’ exposure to risks, and negative effects on the psychological health of both health providers and recipients. Ultimately, the most serious consequence is the ethical consequences.MethodsThis work is based on a review of the literature related to DM worldwide and a comparison with the available knowledge found in Jordan. It is qualitative with a descriptive nature, aiming to diagnose the current DM practice in Jordan.ResultsThis is the first published article that discusses DM in Jordan by diagnosing its ethical and economic consequences for the health system as well as for patients. Despite the knowledge of the reasons that support its practice, little is being done to solve this issue. The absence of agreeable medical malpractice law, the dearth of unified medical protocols, the overwhelming pressure imposed by patients on medical staff, and the deteriorating patient-physician relationship are some of the causes of DM practice. Surely, the solution to these issues is to focus on fortifying the ethical and humanitarian aspects on the side of both the physician and the patient to ensure positive collaboration. The ethical aim of the physician to treat the patient faithfully and do what is possible to help combined with the appreciation of the physician’s efforts and the choice to not take advantage of the physician through litigation could be the most reasonable solution in the near future.ConclusionJordan is suffering from DM due to the limited financial expenditure on the health sector and the impracticality of medical malpractice law. The authors highlight that the cardinal step in solving this dilemma is restoring the ethical dimension of the patient-physician relationship. (shrink)

Hospital health committees in Turkey review medical reports from clinical practitioners and decide whether or not they are justified. As a rule, each HHC member is expected to observe and examine each patient and then evaluate the report. If the report from the patient's doctor is approved, then the Social Security Administration, a state organisation, will meet all of the patient's expenses covering treatment, medication and operations. Justification of health expenditure is crucial for the state because health resources (...) have to be carefully allocated. Conflicts of obligation also generate ethical issues which have to be resolved as well. However, HHCs are not designed to make ethical decisions. An overall concept of organisational ethics needs to be developed. (shrink)

Priority setting is inevitable to control expenditure on expensive medicines, but citizen support is often hampered by the workings of the ‘identified victim effect’, that is, the greater willingness to spend resources helping identified victims than helping statistical victims. In this paper we explore a possible cognitive debiasing strategy that is being employed in discussions on healthcare priority setting, which we call ‘empathy counterbalancing’ (EC). EC is the strategy of directing attention to, and eliciting empathy for, those who might (...) be harmed as a result of one-sided empathy for the very ill who needs expensive treatment. We argue that governments have good reasons to attempt EC because the identified victim effect distorts priority setting in ways that undermine procedural fairness. We briefly outline three areas of application for EC and suggest some possible mechanisms that might explain how EC might work, if at all. We then discuss four potential ethical concerns with EC. First, EC might have the counterproductive effect of reducing overall citizen support for public funding of expensive medical treatments, thereby undermining solidarity. Second, EC may give rise to a ‘competition in suffering’, which may have unintended side effects for patients who feature in attempts at EC. Third, there may be doubts about whether EC is effective. Fourth, it may be objected that EC comes down to emotional manipulation, which governments should avoid. We conclude that insofar these concerns are valid they may be adequately addressed, and that EC seems a promising strategy that merits further investigation. (shrink)

The increasing willingness of people to agree that societies currently spend too much on health care is noted. It is argued that this is more an expression of financial pressures on the state than a reflection of new technological possibilities. The meaning of such statements is questioned in the context of demonstrated social underutilization of skilled personnel and wasteful expenditure. The discussion then focusses on approaches to defining medical need in clinical situations. It is pointed out that this (...) issue has risen to prominence with the establishment of a right to care and the subsequent attempt to define limits to this right. Two basic approaches, the scientific and the subjective, are presented and both are shown to be incapable of providing absolute criteria for decision-making. It is concluded that the issue of establishing needs is a complex technical and political one, where medical ethics can contribute by clarifying the issues and illuminating the alternatives. (shrink)

Virtually all Americans are part of the health care system. They may be patients, health professionals, employers providing benefits, insurers, medical manufacturers, regulators, innovators, or investors. Each has a stake in this burgeoning sector of the United States economy, and each may be critically affected, in multiple and diverse ways, by changes to the system under health reform. As health care expenditures continue to rise, it is increasingly important to understand where these expenditures go and the factors that drive (...) these cost increases. This article examines health care expenditure patterns, considering both the “usual suspects” that frequently are cited as spending drivers, as well as certain significant dynamics that may be the main contributors to rising costs. We conclude that in order to successfully contain costs, health reform will need to address these underlying factors. (shrink)