Allocation of Health Care Resources: Principles for Decision-making.

Abstract

1. Hellen Ransom, DHCE* 2. John M. Olsson, MD, CPE† 1. *Department of Bioethics and Interdisciplinary Studies, 2. †Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, NC * Abbreviations: CT: : computed tomography MCO: : managed care organization MRI: : magnetic resonance imaging Pediatricians engage in making decisions on allocation of health care resources on a daily basis. However, they may not be aware of the ethical principles underlying those decisions and how to apply those principles in the process of allocating health care resources. After completing this article, readers should be able to: 1. Identify the ethical principles that should be considered when making decisions on allocating health care resources. 2. Apply ethical principles in clinical settings with limited health care resources. 3. Discuss the role of the institutional ethics committee in assisting clinicians in making point-of-care health care allocation decisions. Health care resources are defined as all materials, personnel, facilities, funds, and anything else that can be used for providing health care services. Health care has long been a limited resource for which there has been an unlimited demand; everyone needs health care. Until the 20th century, US health care was allocated by the ability to pay or barter, with small numbers of individuals consuming the bulk of the resources, leaving few resources available to others. During the past 100 years, increased interest in good personal and public health resulted in the development of various forms of health insurance. Health insurance became available through employer-sponsored insurance plans and, in the 1960s, entitlement programs—including Medicare and Medicaid. In spite of the presence of these forms of payment, demands for all aspects of health care continue to exceed its available resources. Millions of people in the United States, including children, continue to lack health insurance or avenues to access health care resources. Likewise, the costs associated with health care have increased dramatically as technology has advanced, …