Healthcare Rationing Through Global Budgeting: The Ethical Choices
Veatch, Robert M.
Journal of Clinical Ethics. 1994 Winter; 5(4): 291-296.
With global budgeting, an administrator of a state health plan, a hospital, a specific hospital department, or a health maintenance organization would be given a fixed pile of money with which to provide for the healthcare needs of a group of patients under his or her care. The key to this approach is that funders of healthcare can avoid making specific rationing decisions by giving blocks of money -- global budgets -- to suppliers of healthcare, tailoring the amount so that it is not enough for every physician to do everything for every patient. The administrators of these piles of money would be expected to make do, allocating the limited resources among their patients as best they could. Figuring out how to best allocate the limited funds will be the key political, practical, and ethical question. The choices are not obvious, and no one is giving them the serious attention that they deserve. There are at least three major alternative principles upon which the piles of money -- global budgets -- can be divided into an insurance plan, a hospital, or a hospital department. The choices fundamentally have nothing to do with knowledge of the science or clinical practice of medicine; they have everything to do with basic moral and cultural attitudes about how to live responsibly as a moral community. We could make a good case that clinicians and health facility administrators should not make the decisions for allocating global budgets. There are good reasons why we could expect both clinicians and administrators to divide up the global budgets in a manner that could be considered unethical.
Administrators; Attitudes; Common Good; Costs and Benefits; Consent; Decision Making; Economics; Health; Health Care; Informed Consent; Insurance; Justice; Knowledge; Life; Medicine; Metaethics; Methods; Moral Policy; Patients; Peer Review; Physicians; Policy Analysis; Public Participation; Public Policy; Quality of Life; Resource Allocation; Review; Risks and Benefits; Science; Utilitarianism;
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