DRGs: Justice and the Invisible Rationing of Health Care Resources
Fleck, Leonard M.
Journal of Medicine and Philosophy. 1987 May; 12(2): 165-196.
Are DRGs just? This is the primary question which this essay will answer. But there is a prior methodological question that also needs to be addressed: How do we go about rationally (non-arbitrarily) assessing whether DRGs are just or not? I would suggest that grand, ideal theories of justice (Rawls, Nozick) have only very limited utility for answering this question. What we really need is a theory of "interstitial justice," that is, an approach to making justice judgments that is suitable to assessing the social practices and institutions that comprise the interstices of our social life as opposed to its basic structure. Rawls's appeal to "our considered moral judgments" provides us with a useful starting point for this task, which we shall discuss in the first part of this essay. In the second part, we shall actually assess DRGs from the perspective of interstitial justice....
Aged; Costs and Benefits; Decision Making; Diagnosis; Economics; Federal Government; Financial Support; Government; Health; Health Care; Health Care Delivery; Hospitals; Justice; Life; Moral Policy; Obligations of Society; Patient Admission; Philosophy; Physicians; Political Systems; Public Policy; Remuneration; Resource Allocation; Rights; Rationing of Health Care; Selection for Treatment; Socioeconomic Factors; Values;
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Fleck, Leonard M. (1990-04)Fleck divides his paper on health care rationing into three parts. In the first part, he presents and critically assesses the moral problems posed by invisible rationing mechanisms. He claims that such mechanisms, by being ...