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Who should manage care? The case for patients
Insights
Healthcare rationing is necessary. This study argues against clinicians making allocation decisions, proposing patient-led rationing as a fairer and more efficient approach for resource management.
Area of Science:
- Medical Ethics
- Health Economics
- Public Health Policy
Background:
- Healthcare resources are finite, necessitating rationing.
- The role of clinicians as gatekeepers in healthcare allocation is a contentious issue.
- Existing models of healthcare rationing face significant ethical and practical challenges.
Purpose of the Study:
- To evaluate the suitability of clinicians as decision-makers in healthcare rationing.
- To explore alternative models for fair and efficient healthcare resource allocation.
- To advocate for patient involvement in healthcare rationing decisions.
Main Methods:
- Critical analysis of arguments for and against clinician-led healthcare rationing.
- Examination of clinician information deficits and ethical conflicts in allocation.
- Evaluation of alternative decision-making bodies, including physicians, administrators, and patients.
- Exploration of patient-led rationing mechanisms at societal and individual levels.
Main Results:
- Bedside clinicians lack adequate information for optimal allocation decisions.
- Physicians' adherence to the Hippocratic ethic can lead to suboptimal resource use.
- Both physicians and administrators are likely to err in allocation decisions.
- Patient-led rationing emerges as a superior alternative for resource allocation.
Conclusions:
- Clinician-led healthcare rationing is fraught with informational and ethical limitations.
- Patient empowerment in resource allocation decisions offers a more equitable and efficient system.
- Developing mechanisms for patient-led rationing is crucial for fair healthcare resource management.
Abstract:
After establishing that it is essential that health care be rationed in some fashion, the paper examines the arguments for and against clinicians as gatekeepers. It first argues that bedside clinicians do not have the information needed to make allocation decisions. Then it claims that physicians at the bedside can be expected to make the wrong choice for two reasons: their commitment to the Hippocratic ethic forces them to pursue the patient's best interest (even when resources will produce only very marginal benefit and could do much more good elsewhere) and their values will lead them to calculate the net value of treatments incorrectly. Alternative decision makers are considered. It is argued that both groups of physicians and administrators will also make allocations incorrectly and that leaving the allocation decisions to patients themselves is the best approach. Mechanisms for fair and efficient rationing by patients at the societal and individual level are examined.