Chapter 17.Allocation of Scarce Resources and Health Care Reform

Abstract

Ethical concerns in public health often relate to the just allocation of scarce resources, including health care services. The importance of this topic is indisputable today in this era of budgetary constraints and health care reform. Because of rising health care costs and finite resources, it is impossible to provide every procedure or preventive measure that might possibly benefit every individual and still manage to care for everyone (Smith 1996). Even in managed care, efforts to control costs may conflict with health care providers' obligations to advocate on behalf of patients who need costly services. This tension between doing what is best for the patient and ensuring a just allocation of scarce resources is at the heart of managed care ethics. Whereas physicians have traditionally been guided by principles of autonomy and beneficence in the context of being their patient's advocate, institutions such as HMOs are guided instead by notions of efficiency, cost‐effectiveness, cost reduction, and optimal resource allocation (Perkel 1996). The challenge is to find an equitable way to distribute health care resources that does not unduly conflict with other ethical principles.