Justice and the Allocation of Health Care Resources

  • Nancy S. Jecker

Abstract

There is growing concern in the United States, and in many other developed nations, that health care expenditures are too high and are growing too rapidly. Between 1950 and 1990 United States health expenditures grew 3% per annum faster than expenditures for other goods and services. Economists forecast that if health spending in the United States continues to outpace other areas of the economy at this rate, by 2030 health care will consume almost one third of the gross national product.1

Keywords

Health Care Expenditure Health Care Resource Medical Benefit Basic Health Care Health Care Rationing 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Fuchs V. No Pain, no gain: perspectives on cost containment. JAMA. 1993; 269: 631–633.PubMedCrossRefGoogle Scholar
  2. 2.
    US Senate Special Committee on Aging. Aging America: Trends and Projections. Washington, DC: Public Health Service, US Dept of Health and Human Services; 1985–86.Google Scholar
  3. 3.
    Schneider EL, Guralnik JM. The aging of America. JAMA. 1990; 263: 2335–2340.PubMedCrossRefGoogle Scholar
  4. 4.
    Temkin-Greener HA, Meiners MR, Petty EA, et al. The use and cost of health services prior to death: a comparison of the Medicare-only and the Medicare-Medicaid elderly populations. Milbank Q. 1992; 70: 679–701.PubMedCrossRefGoogle Scholar
  5. 5.
    Angell M. Cost containment and the physician. JAMA. 1985; 254: 1203–1207.PubMedCrossRefGoogle Scholar
  6. 6.
    Leaf A. The doctor’s master. JAMA. 1984; 311: 1573–1575.Google Scholar
  7. 7.
    Stern RS, Weissman JS, Epstein AM. The emergency department as a pathway to admission for poor and high-cost patients. JAMA. 1991; 266: 2238–2243.PubMedCrossRefGoogle Scholar
  8. 8.
    Burstin HR, Lipsitz SR, Brennan TA. Socioeconomic status and risk for substandard care. JAMA. 1992; 268: 2283–2287.CrossRefGoogle Scholar
  9. 9.
    Pappas G, Queen S, Hadden W, et al. The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. N Engl J Med. 1993; 329: 103–109.PubMedCrossRefGoogle Scholar
  10. 10.
    Angell M. Privilege and health. N Engl J Med. 1993; 329: 126–127.PubMedCrossRefGoogle Scholar
  11. 11.
    Baker DW, Stevens CD, Brook RH. Patients who leave a public hospital emergency department without being seen by a physician. JAMA. 1991; 266: 1085–1090.PubMedCrossRefGoogle Scholar
  12. 12.
    Kellerman AL. Too sick to wait. JAMA. 1991; 266: 1123–1125.CrossRefGoogle Scholar
  13. 13.
    Bindman AB, Grumbach K, Keane D, et al. Consequence of queuing for care at a public hospital emergency department. JAMA. 1991; 266: 1091–1096.PubMedCrossRefGoogle Scholar
  14. 14.
    Olson CM. Hospital admission through the emergency department: an obstructed pathway. JAMA. 1991; 266: 2274.Google Scholar
  15. 15.
    Kellerman AL, Andrulis DP, Hackman BB. Emergency department overcrowding. Ann Emerg Med. 1990; 19: 447.CrossRefGoogle Scholar
  16. 16.
    Grumet GW. Health care rationing through inconvenience. N Engl J Med. 1989; 321: 607–611.PubMedCrossRefGoogle Scholar
  17. 17.
    Barondess JA, Kalb P, Weil WB, et al. Clinical decision-making in catastrophic situations: the relevance of age. J Am Geriatr Soc. 1988; 36: 919–937.PubMedGoogle Scholar
  18. 18.
    Jecker NS. Age-based rationing and women. JAMA. 1991; 266: 3012–3015.PubMedCrossRefGoogle Scholar
  19. 19.
    Jecker NS. Can an employer based health insurance system be just? J Health Polit Policy Law. 1993; 18: 657–674.CrossRefGoogle Scholar
  20. 20.
    Trevino FM, Moyer E, Valdez B, et al. Health insurance coverage and utilization of health services by Mexican Americans, Mainland Puerto Ricans, and Cuban Americans. JAMA. 1991; 265: 233–237.PubMedCrossRefGoogle Scholar
  21. 21.
    Davidson EC, Fukushima T. The racial disparity in infant mortality. N Engl J Med. 1992; 327: 1022–1024.PubMedCrossRefGoogle Scholar
  22. 22.
    Becerra JE, Hogue CJR, Atrash HK, Perez N. Infant mortality among Hispanics. JAMA. 1991; 265: 217–221.PubMedCrossRefGoogle Scholar
  23. 23.
    Hilts PJ. Growing gap in life expectancies of blacks and in whites is emerging. New York Times. October 9, 1989: A1.Google Scholar
  24. 24.
    Kasiske BL, Neylan JF, Riggio RR, et al. The effect of race on access and outcome in transplantation. N Engl J Med. 1991; 324: 302–307.PubMedCrossRefGoogle Scholar
  25. 25.
    Kjellstrand CM. Age, sex, and race inequality in renal transplantation. Arch Intern Med. 1988; 148: 1305–1309.PubMedCrossRefGoogle Scholar
  26. 26.
    Gaston RS, Ayres I, Dooley LG, et al. Racial equity in renal transplantation: the disparate impact of HLA-based allocation. JAMA. 1993; 270: 1352–1356.PubMedCrossRefGoogle Scholar
  27. 27.
    Ayanian JZ, Udvarhelyi S, Gatsonis CA, et al. Racial differences in the use of revascularization procedures after coronary angiography. JAMA. 1993; 269: 2642–2646.PubMedCrossRefGoogle Scholar
  28. 28.
    Becker LB, Han BH, Meyer PM, et al. Racial differences in the incidence of cardiac arrest and subsequent survival. N Engl J Med. 1993; 329: 600–605.PubMedCrossRefGoogle Scholar
  29. 29.
    Whittle J, Conigliaro J, Good CB, Lofgren RP. Racial differences in the use of invasive cardiovascular procedures in the department of veterans affairs medical system. N Engl J Med. 1993; 329: 621–626.PubMedCrossRefGoogle Scholar
  30. 30.
    Ayanian JZ. Heart disease in black and white. N Engl J Med. 1993; 329: 656–658.PubMedCrossRefGoogle Scholar
  31. 31.
    Todd KH, Samaroo N, Hoffman JR. Ethnicity as a risk factor for inadequate emergency department analgesia. JAMA. 1993; 269: 1537–1539.PubMedCrossRefGoogle Scholar
  32. 32.
    Moore RD, Stanton D, Gopalan R, et al. Racial differences in the use of drug therapy for HIV disease in an urban community. N Engl J Med. 1994; 330: 763–768.PubMedCrossRefGoogle Scholar
  33. 33.
    Strosberg MA, Wiener JM, Baker R, et al. Rationing America’s Medical Care: The Oregon Plan and Beyond. Washington, DC: Brookings Institute; 1992.Google Scholar
  34. 34.
    Hadorn D. Setting health care priorities in Oregon. JAMA. 1991; 265: 2218–2225.PubMedCrossRefGoogle Scholar
  35. 35.
    Egan T. Oregon shakes up pioneering health plan for the poor. New York Times. February 22, 1991: A11.Google Scholar
  36. 36.
    Winslow G. Triage and Justice. Berkeley: University of California Press; 1982.Google Scholar
  37. 37.
    Kilner J. Who Lives? Who Dies?: Ethical Criteria in Patient Selection. New Haven, CT: Yale University Press; 1990.Google Scholar
  38. 38.
    Jecker NS, Pearlman RA. An ethical framework for rationing health care. J Med Philos. 1992; 17: 79–96.PubMedCrossRefGoogle Scholar
  39. 39.
    Callahan D. Setting Limits. New York: Simon Schuster; 1987: 137.Google Scholar
  40. 40.
    Lamm RD. Ethical care for the elderly, In: Smeeding TM, ed. Should Medical Care Be Rationed By Age? Totowa, NJ: Rowman and Littlefield; 1987:xi-xv.Google Scholar
  41. 41.
    Preston S. Children and the elderly. Sci Am. 1984; 251: 44–49.PubMedCrossRefGoogle Scholar
  42. 42.
    Daniels N. Am I My Parents’ Keeper? New York: Oxford University Press; 1988.Google Scholar
  43. 43.
    Wenger NK, O’Rourke RA, Marcus FI. The care of elderly patients with cardiovascular disease. Ann Intern Med. 1988; 109: 425–428.PubMedGoogle Scholar
  44. 44.
    Jecker NS, Pearman RA. Ethical constraints on rationing medical care by age. J Am Geriatr Soc. 1989; 37: 1067–1075.PubMedGoogle Scholar
  45. 45.
    Jecker NS. Disenfranchising the elderly from life-extending medical care. Public Affairs Q. 1988; 2: 51–68.Google Scholar
  46. 46.
    Kilner J. Age as a basis for allocating lifesaving medical resources. J Health Polit Policy Law. 1988; 13: 405.PubMedCrossRefGoogle Scholar
  47. 47.
    Jonsen A. Resentment and the rights of the elderly. In: Jecker NS, ed. Aging and Ethics. Clifton, NJ: Humana Press; 1991: 341–352.Google Scholar
  48. 48.
    Jecker NS. Age-based rationing and women. JAMA. 1991; 266: 3012–3015.PubMedCrossRefGoogle Scholar
  49. 49.
    Cassel CK, Neugarten BL. A forecast of women’s health and longevity. Western J Med. 1988; 149: 712–749.Google Scholar
  50. 50.
    Verbrugge LM. An epidemiological profile of older women. In: Haug MR, Amasa B, Ford MS, eds. The Physical and Mental Health of Aged Women. New York: Springer; 1985: 41–64.Google Scholar
  51. 51.
    Gutmann A. For and against equal access to health care. In President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Securing Access to Health Care. Vol. 2. Washington, DC: Government Printing Office; 1983: 51–66.Google Scholar
  52. 52.
    Buchanan A. An ethical evaluation of health care in the United States. In: HM Sass, R Massey, eds. Health Care Systems. Boston: Kluwer Academic; 1988:39–58.Google Scholar
  53. 53.
    Daniels N. Just Health Care. New York: Cambridge University Press; 1985.CrossRefGoogle Scholar
  54. 54.
    Outka G. Social justice and equal access to health care. In: Gorovitz S, Macklin R, Jameton AL, et al., eds. Moral Problems in Medicine. 2nd ed. Englewood Cliffs, NJ: Prentice-Hall; 1983:544–557.Google Scholar
  55. 55.
    Jecker NS, Meslin EM. United States and Canadian approaches to justice in health care. Theor Med. 1994; 15: 181–200.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1997

Authors and Affiliations

  • Nancy S. Jecker

There are no affiliations available

Personalised recommendations