Abstract
BackgroundHealthcare systems are increasingly struggling with resource constraints, given demographic changes, technological development, and citizen expectations. The aim of this article is to normatively analyze different suggestions regarding how publicly financed plastic surgery should be delineated in order to identify a well-considered, normative rationale. The scope of the article is to discuss general principles and not define specific conditions or domains of plastic surgery that should be treated within the publicly financed system.MethodsThis analysis uses a reflective equilibrium approach, according to which considered normative judgements in one area should be logically and argumentatively coherent with considered normative judgements and background theories at large within a system.Results and conclusionsIn exploring functional versus non-function conditions, we argue that it is difficult to find a principled reason for an absolute priority of functional conditions over non-functional conditions. Nevertheless, functional conditions are relatively easier to establish objectively, and surgical intervention has a clear causal effect on treating a functional condition.Considering non-functional conditions that require plastic surgery [i.e., those related to appearance or symptomatic conditions (not affecting function)], we argue that the patient needs to experience some degree of suffering (and not only a preference for plastic surgery), which must be ‘validated’ in some form by the healthcare system.This validation is required for both functional and non-functional conditions. Functional conditions are validated by distinguishing between statistically normal and abnormal functioning. Similarly, for non-functional conditions, statistical normality represents a potential method for distinguishing between what should and should not be publicly funded. However, we acknowledge that such a concept requires further development.
Highlights
Healthcare systems are increasingly struggling with resource constraints, given demographic changes, technological development, and citizen expectations
We evaluate whether different etiologies of a non-functional condition should make a difference in whether the problem can be assessed as norm
Healthcare need and the distinction between functional and non-functional conditions In publicly financed, welfare-type healthcare systems, the concept of healthcare need is essential to determining whether interventions are reimbursed [16]
Summary
Healthcare systems are increasingly struggling with resource constraints, given demographic changes, technological development, and citizen expectations. Other interventions are more disputed, and there is ongoing discussion regarding reimbursement and rationing in plastic surgery [2,3,4]. Even under these conditions, the threshold concerning what should be offered in a publicly funded system remains to be determined. There is increasing pressure from citizens to offer plastic surgery in the publicly funded healthcare system based on the perceived changes in need and expectations according to influences from the media [7, 8], Internet [9], and social factors [10]
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