Rationing of medical care: Rules of rescue, cost-effectiveness, and the Oregon plan.
Doctors who deal with individual patients fail to avoid interventions with minimal expected benefits. This is one reason that the United States spends more on health care services than any of 28 other industrialized nations. Yet, our money has not bought us health; our infant mortality rate ranks 23rd, and our overall life expectancy rate ranks 20th among the 29 nations. Ours is the only nation without a national health system. Our job-based health insurance system has allowed the number of uninsured persons to reach 44 million, which is 18% of the nonelderly population. This article examines the role of such ethical concepts as beneficence, utilitarianism, and justice in the allocation of health care resources. It also examines the innovative Oregon Health Plan and its use of cost-effectiveness analysis for health care allocation that is based on league tables.
Department of Obstetrics and Gynecology, Stanford University, CA, USA.
Emmet J
EJ
Lamb
D003363:Cost Control / Q000379:methods*; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D015276:Health Care Rationing / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D006801:Humans; D017057:Medically Uninsured / Q000706:statistics & numerical data; D009922:Oregon; D016730:Program Development; D015397:Program Evaluation; D040841:Resource Allocation; D013221:State Health Plans / Q000191:economics* / Q000331:legislation & jurisprudence; D014481:United States