© 2008 delmar cengage learning. chapter 1 values in health policy: understanding fairness and...
TRANSCRIPT
![Page 1: © 2008 Delmar Cengage Learning. Chapter 1 Values in Health Policy: Understanding Fairness and Efficiency Deborah Stone](https://reader030.vdocument.in/reader030/viewer/2022033105/56649ebd5503460f94bc5db9/html5/thumbnails/1.jpg)
© 2008 Delmar Cengage Learning.
Chapter 1
Values in Health Policy:Understanding Fairness and
EfficiencyDeborah Stone
![Page 2: © 2008 Delmar Cengage Learning. Chapter 1 Values in Health Policy: Understanding Fairness and Efficiency Deborah Stone](https://reader030.vdocument.in/reader030/viewer/2022033105/56649ebd5503460f94bc5db9/html5/thumbnails/2.jpg)
© 2008 Delmar Cengage Learning.
2
Values in Health Care: Fairness and Efficiency
• Broad agreement on desirability of both values in principle– But difficult, if not impossible, to achieve
consensus on realizing both
• “Inherent tension” between the two
• Multiple definitions of both– Depending on one’s perspective
![Page 3: © 2008 Delmar Cengage Learning. Chapter 1 Values in Health Policy: Understanding Fairness and Efficiency Deborah Stone](https://reader030.vdocument.in/reader030/viewer/2022033105/56649ebd5503460f94bc5db9/html5/thumbnails/3.jpg)
© 2008 Delmar Cengage Learning.
3
Efficiency Defined
• Most simply, efficiency can be conceived as a bargain– With the ideal of achieving the highest ratio of
outputs to input
• Myth: efficiency can be measured – Efficiency can only be properly defined in
reference to an individual, party, or constituency
![Page 4: © 2008 Delmar Cengage Learning. Chapter 1 Values in Health Policy: Understanding Fairness and Efficiency Deborah Stone](https://reader030.vdocument.in/reader030/viewer/2022033105/56649ebd5503460f94bc5db9/html5/thumbnails/4.jpg)
© 2008 Delmar Cengage Learning.
4
Efficiency in Practice
• “The Waiting Room Game”– Efficiency from doctor’s point of view
• Always having patient available to treat, thus filling waiting room
– Does not factor in wasted time on the part of patients – One person’s efficient outcome represents another’s
wasted time/resources
![Page 5: © 2008 Delmar Cengage Learning. Chapter 1 Values in Health Policy: Understanding Fairness and Efficiency Deborah Stone](https://reader030.vdocument.in/reader030/viewer/2022033105/56649ebd5503460f94bc5db9/html5/thumbnails/5.jpg)
© 2008 Delmar Cengage Learning.
5
Contesting Fairness: Actuarial Fairness vs. the Solidarity Principle
• Actuarial fairness stressed by certain insurers beginning in 1980s– Tied cost of insurance premium to an
individual’s risk– Rhetorically asking why one should be forced
to finance another’s risks
![Page 6: © 2008 Delmar Cengage Learning. Chapter 1 Values in Health Policy: Understanding Fairness and Efficiency Deborah Stone](https://reader030.vdocument.in/reader030/viewer/2022033105/56649ebd5503460f94bc5db9/html5/thumbnails/6.jpg)
© 2008 Delmar Cengage Learning.
6
Contesting Fairness: Actuarial Fairness vs. the Solidarity Principle
• Solidarity principle/ideal more closely approximated in European systems– Society at large funds the care of the sick and
those (otherwise) least able to finance care
![Page 7: © 2008 Delmar Cengage Learning. Chapter 1 Values in Health Policy: Understanding Fairness and Efficiency Deborah Stone](https://reader030.vdocument.in/reader030/viewer/2022033105/56649ebd5503460f94bc5db9/html5/thumbnails/7.jpg)
© 2008 Delmar Cengage Learning.
7
Actuarial Fairness in Practice• Insurers first sought to exclude racial
minorities for their “greater risk”
• Despite laws seeking to reform such practices:– Minorities in some areas, as well as those
suffering from certain diseases, find themselves unable to receive coverage
![Page 8: © 2008 Delmar Cengage Learning. Chapter 1 Values in Health Policy: Understanding Fairness and Efficiency Deborah Stone](https://reader030.vdocument.in/reader030/viewer/2022033105/56649ebd5503460f94bc5db9/html5/thumbnails/8.jpg)
© 2008 Delmar Cengage Learning.
8
Actuarial Fairness in Practice
• Many insurers continue to perfect ways to further fragment market– Closely matching premiums to level of risk
• While excluding certain groups altogether
![Page 9: © 2008 Delmar Cengage Learning. Chapter 1 Values in Health Policy: Understanding Fairness and Efficiency Deborah Stone](https://reader030.vdocument.in/reader030/viewer/2022033105/56649ebd5503460f94bc5db9/html5/thumbnails/9.jpg)
© 2008 Delmar Cengage Learning.
9
The SolidarityPrinciple in Practice
• Seeks to accomplish the ideal of basing distribution of medical care on the basis of need– Not ability to pay
• Assumes that the community should be responsible for the cost of care for the infirm
![Page 10: © 2008 Delmar Cengage Learning. Chapter 1 Values in Health Policy: Understanding Fairness and Efficiency Deborah Stone](https://reader030.vdocument.in/reader030/viewer/2022033105/56649ebd5503460f94bc5db9/html5/thumbnails/10.jpg)
© 2008 Delmar Cengage Learning.
10
The SolidarityPrinciple in Practice
• Represents subsidy from the vast majority to the minority– Underlying principle of social insurance
![Page 11: © 2008 Delmar Cengage Learning. Chapter 1 Values in Health Policy: Understanding Fairness and Efficiency Deborah Stone](https://reader030.vdocument.in/reader030/viewer/2022033105/56649ebd5503460f94bc5db9/html5/thumbnails/11.jpg)
© 2008 Delmar Cengage Learning.
11
Efficiency and Fairness in the American Health Care System
• Current system infused with the spirit of actuarial fairness– Difficult to overcome
![Page 12: © 2008 Delmar Cengage Learning. Chapter 1 Values in Health Policy: Understanding Fairness and Efficiency Deborah Stone](https://reader030.vdocument.in/reader030/viewer/2022033105/56649ebd5503460f94bc5db9/html5/thumbnails/12.jpg)
© 2008 Delmar Cengage Learning.
12
Efficiency and Fairness in the American Health Care System
• Neither efficiency, nor fairness are “neutral criteria” through which to judge quality of health care system– They are values that have different meanings
to different people
![Page 13: © 2008 Delmar Cengage Learning. Chapter 1 Values in Health Policy: Understanding Fairness and Efficiency Deborah Stone](https://reader030.vdocument.in/reader030/viewer/2022033105/56649ebd5503460f94bc5db9/html5/thumbnails/13.jpg)
© 2008 Delmar Cengage Learning.
13
Efficiency and Fairness in the American Health Care System
• There will always be winners and losers in nearly any health care system
![Page 14: © 2008 Delmar Cengage Learning. Chapter 1 Values in Health Policy: Understanding Fairness and Efficiency Deborah Stone](https://reader030.vdocument.in/reader030/viewer/2022033105/56649ebd5503460f94bc5db9/html5/thumbnails/14.jpg)
© 2008 Delmar Cengage Learning.
14
Chapter 1 Summary
• Fairness and efficiency – Two values crucial to any health policy debate
• Idea of efficiency requires one to define specific perspective
![Page 15: © 2008 Delmar Cengage Learning. Chapter 1 Values in Health Policy: Understanding Fairness and Efficiency Deborah Stone](https://reader030.vdocument.in/reader030/viewer/2022033105/56649ebd5503460f94bc5db9/html5/thumbnails/15.jpg)
© 2008 Delmar Cengage Learning.
15
Chapter 1 Summary
• Central to the idea of fairness– Tension between actuarial fairness and the
solidarity principle
• Contemporary health care system tends to favor actuarial fairness over solidarity