Justice, HMOs, and the Invisible Rationing of Health Care Resources
Fleck, Leonard M.
Bioethics. 1990 Apr; 4(2): 97-120.
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 localized, privitized, and unofficial, violate Rawls's publicity condition that is an essential part of our concept of justice. In the second part, he analyzes and criticizes the role that prospective payment mechanisms such as health maintenance organizations (HMOs), diagnosis-related groups (DRGs), and Great Britain's National Health Service play as invisible rationing mechanisms. He suggests that if HMOs could be structured so as to satisfy the publicity condition, a national system of HMOs could achieve cost containment objectives. In the third part of his paper, Fleck describes such a system of HMOs in detail, and assesses it from the perspective of justice. (KIE abstract)
Biomedical Technologies; Containment; Costs and Benefits; Decision Making; Diagnosis; Disclosure; Economics; Financial Support; Health; Health Care; Health Care Delivery; Health Facilities; Health Maintenance Organizations; Health Care Rationing; Incentives; Justice; Moral Policy; Organizations; Physician Patient Relationship; Physicians; Policy Analysis; Public Participation; Public Policy; Remuneration; Resource Allocation; Rights; Rationing of Health Care; Selection for Treatment; Values;
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Fleck, Leonard M. (1987-05)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 ...