Abstract
Any health care system should be grounded in the ethical principle of fairness in access to services and the economic principle of efficiency in allocating resources. In this paper, I explore the relationship between ethics and economics in possible two-tiered rationing schemes in American and Canadian systems. In the US, rationing through managed care occurs in the form of constraints on the type and number of services doctors perform. In Canada, rationing occurs in the form of queuing, with comparatively long periods of waiting time for surgery and other treatments. Managed care organizations in the US have temporarily increased efficiency in the delivery of care by reducing waste and unnecessary services, but not fairness, as evidenced by the 44 million uninsured and underinsured. I consider whether adopting a universal model along the lines of the Oregon Basic Health Services Act might ensure both fairness and efficiency. On this model, guaranteeing that all Americans had a decent basic minimum of health care would mean excluding some expensive treatments from health plans, though people with the ability to pay for these treatments might have them. Such a two-tiered system would be fair provided that the lower tier entailed a decent minimum that met people’s basic health care needs. Tiering in the Canadian system would involve allowing those with the ability to pay for expedited care to jump the queue and thereby cut their waiting time. This might ameliorate the problem of waiting for people who cannot afford to jump the queue because they are unable to pay for expedited care.
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Endnotes and References
Daniel Callahan, “Rationing Health Care: Social, Political, and Legal Perspectives,” American Journal of Law and Medicine 18 (1992): 1–16. Uwe Reinhardt, “Reforming the Health Care System: The Universal Dilemma,” ibid., 19 (1993): 1–20.
Michael Lockwood, “Quality of Life and Resource Allocation,” in J.M. Bell and S. Mendus, eds., Philosophy and Medical Welfare (Cambridge: Cambridge University Press, 1988): 33–56. John Broome, “Goods, Fairness, and QALYs,” ibid.: 57–74; John Harris, “More and Better Justice,” ibid.: 75–96.
John Rawls, A Theory of Justice (Cambridge, MA: Belknap Harvard University Press, 1971): 7–11, 40 ff., and “Social Unity and Primary Goods,” in B. Williams and A. Sen, eds., Utilitarianism and Beyond (Cambridge: Cambridge University Press, 1982); 159–185.
Derek Parfit, “Equality or Priority?”, Lindley Lecture, University of Kansas, 1995. Thomas Nagel, Equality and Partiality (Oxford: Oxford University Press, 1991).
Allen Buchanan, “The Right to a Decent Minimum of Health Care,” Philosophy &v Public Affairs 13 (1984): 55–78.
John K. Iglehart, “Canada’s Health Care System Faces its Problems,” New England Journal of Medicine 322 (February 22, 1990): 562–568, and “Revisiting the Canadian Health Care System,” New England Journal of Medicine 342 (June 20, 2000): 2007–2012; C. J. Tuohy, Accidental Logics: The Dynamics of Change in the Health Care Arenas in the United States, Britain, and Canada (New York: Oxford University Press, 1999); M. Kennedy, “73 Percent Back Private Health Care: Most Canadians in Favour of Two-Tiered System if it Means ‘Timely Access’ to Care, Survey Finds,” Ottawa Citizen, January 22, 2000.
Daniel Callahan, “Rationing Health Care: Social, Political, and Legal Perspectives,” American Journal of Law and Medicine 18 (1992): 4.
Larry Churchill, Rationing Health Cure in America (Notre Dame, IN: University of Notre Dame Press, 1987): 95 ff.
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© 2002 Kluwer Academic Publishers
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Glannon, W. (2002). Rationing Health Care in the United States and Canada. In: Loewy, E.H., Loewy, R.S. (eds) Changing Health Care Systems from Ethical, Economic, and Cross Cultural Perspectives. Springer, Dordrecht. https://doi.org/10.1007/0-306-46846-8_12
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DOI: https://doi.org/10.1007/0-306-46846-8_12
Publisher Name: Springer, Dordrecht
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