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    Chapter 4 Health Policy And The Functions Of Health Care

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    14 views28 pages

    Chapter 4 Health Policy and The Functions of Health Care

    Uploaded by

    Beka

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    of 28
    CHAPTER IV HEALTH POLICY AND THE FUNCTIONS OF HEALTH CARE jealth Po! ‘ert The analysis of justice in health care I presented, in principle, supports the political call for securing access to the central forms of health care for everybody. Access must be such that everyone has the means to get the health care he is entitled to through the central functions. Formal access which cannot be taken advantage of because one cannot afford to pay does net count for much when we are sincerely agency of others and interested to sustain the moral ourselve! Teeartiea “Fantien justice leaves open the ques-tcn eg fee Penitr eece de to be provided and how the healiaicess ag Pipriterssrecogs ror thenselves should be financed im Be iia nich necd tobe cbeezvedl Reece ia eee nem ee care 1s eftective and cha fearless Te Aer Chon enough a burden on the scesc aaa Gigtrinuted by Ce yi) an a result have less, Soap deduce incomes. Wetaniiok vouls Saints decide velther ia liag the most 16 n important currently competing models of health care provision nor payment systems. In the provision of health care models of what is called “managed care" and "fee-for-service" nedicine are the two most important approaches. In managed care, the primary provider of health care is an institution, not a physician. Within this institution, usually a so called "health maintenance organization" (HMO), employed physicians distribute services among patients according to the rules and criteria of the institution. Managed care is becoming the dominant model of provision in the U.S.. In contrast, in cro-allocations are made fairly autonomously by Germany individual physicians who are generally vorking on a tee-for- ervice basis, and only in hospitals micro-allocations are nade according: to institutional rules. However, both nodels efi provision are, in principle, capablelvot/disteibutiog servicessin:a) way that the central: functions: of:healthicare Sretnot kéageticed for the :peripheralotunchiopsymas@nongeas PiSvidergimecopriize thermore]: Muportanas taaeelsimeme 2p. Comnany ;ephysioSans:intembalstotysonkei cE Sia YiNsae itestecraccnrases: fixed budgdbureniot SiSeeM= sae wee dia thisansted .nysenesphy’siclanstaxongveetienttine tas Gacttoee etm: axmoet: any:posaibie way~ This PeClers ei Sota bbbetnciplesectt nicro-ailecattonoutieaia binding for a Righinianinn vouls argue:that principlemed nicro-allocation, Revivanpe:acte bextrenely:cimportaut } Form just health care 78 distribution. Without such principles, even an impartially just total budget can be too high and too low at the same time. It can be too high for the peripheral functions of health care and too low for the central functions. this unjust distribution appears to be the case in Germany in the sector of ambulatory care. Germany, together with gapan, has the highest number of physician-office visits, averaging 11 visite per person per year (in comparison the U.S. has only 6 visits). Most of these visits concern minor ailments such as mild headaches, infections, or the reneval of standing presoriptions..-In») contrast, potentially 1ife-saving and disability-preventing' health services appear to be much underused. moigivetsjust-one exemple, Germany (unlikesthe:UsGoEsthe TattedyKingdoa).sdoes not have acnationalcprogras itor heart Aissksdeyecventionevbicinccoult sbetiierlestoeet sagt the Highs nthimusdn.yearry officecvisite salt ntignsee aie cag Batcindidiexoqtrscen = comparable cocuesl coe mortality from Geeceeatan~tncaccticn (enky -cxen raiser entamtlyertoipaney ein wes wg Projects. mitewaygnis, iaccpossibleqbecsune:s oGMeDeMim ste Bes exeigpve, cyatenisunich: GFT eGme nas ‘education i care, housing, and (naintdageuniymraity education) heal aCe i ia political or communiti in the health care expenditures activities. To the public financing of . the extent that an increase would put. these benefits also a risk, it might in fact an adequate level of Peibtnedworst-off to less: thaliny deat capabilities. It is beyond the scope of this analysis to predict at shat percentage of the gross national product (GNP) spent on health care this point would be reached, although the strict Limitation of expenditures currently enforced by the government. together with a total lack of interest in targetting the expenditures at the central functions of health care seem to be the two biggest ethical problens for the allocation of resources in the German health care system: he Unites Shactingxiceccstates; only thotwntate £24 COSE OOM aaa position to get some care in case American is normally in Repenaryetctes pe aven:tife=sevingncr aisability-preventing : those who are not able to elective services can be denied t° pay. 87 The dependency of the extent and quality of all types of care on the ability to pay is clearly unjust since it includes the central functions of health care. It implies that society is not prepared to make the sacrifices necessary to we the moral agency of those who cannot provide for their own health care or have in the past chosen not to do s0, Although we would not have an obligation to provide those vith resources that have chosen to squander (or not to insure against bad luck) their assets, at least beyond a minimally adequate level of welfare, we cannot leave unattended those vho chose not to take out health insurance although they Ratia ihqverdapenso. fron: their income.tinstead a sdusiaceiLAmnae Riiaanantonekto: bevuninsured, since it isipart/cihthe Meh Be sitionittet: we can come into situaticnsivbersivalarela=2 Pieropuidtalyieeirmuredy andr wouldsoesillis: ton Goel treated nould not allow anyone to neverthel: It appears that we SI Rciikastnenredmeyainst pronature-deatheandMeshere disability FP aret fuerittiouge: everryonesshould be: SrUsse unSSIGSSST se of Ds ctasah eapered: tress = eth kieaniaee alan illness. Biibind im ewvanetheyindo;sethen Derr Sits shoulda in 4 more extensive principle have an opportunity to buy a mor coverage for the central functions verrtits Games Mai they ¢ Liberties. on the other hand, enjoy as part of their basil or additional insurance if the state can reguiate the market f a8 this benfits the central health care of those who are at the highest risk of premature death or illness, regardless of whether they are rich or poor. In Germany, it has been made difficult (but not impossible) for the better-off to buy better care in order to rise the standard coverage to the highest possible level of quality. In the U.S., the negative impact of making it easy for the better-off to leave the insurance system that covers most people on the quality of Mite: ostiniol cannct.opt out of tthe ipubldchayatamds sel? mfficiently “recognized in the health) policy: debatey\\and needa to \bes taken into consideration when’ solutions: \for coveringtéveryone!with insurance’ for’ the‘central:tunctions of h 1th care are sought. Freie ii coceraanysimicr sani ocsti che Rime hat oan iss dei dirsveratery cargetteduat: thecoenttoaletiqpions ig ddkoveverycthis sppaarestysPSRPeEE Te? to a ts do not cover the Pek tenediaere. than cin: camary ec NoatelNO ieee ot Beets aathese: ninccestimentexthxtioge ears large part es, such as headaches or Ghlctrasiytutentailatory care resources Sy n as put some focus on Waa ee dine) x1s0; managed’ care vba (Giecades'covecentnents ot order:

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