Is a larger patient benefit always better in healthcare priority setting?

IF 2.3 2区 哲学 Q1 ETHICS
Medicine Health Care and Philosophy Pub Date : 2024-09-01 Epub Date: 2024-06-01 DOI:10.1007/s11019-024-10208-9
Lars Sandman, Jan Liliemark, Erik Gustavsson, Martin Henriksson
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Abstract

When considering the introduction of a new intervention in a budget constrained healthcare system, priority setting based on fair principles is fundamental. In many jurisdictions, a multi-criteria approach with several different considerations is employed, including severity and cost-effectiveness. Such multi-criteria approaches raise questions about how to balance different considerations against each other, and how to understand the logical or normative relations between them. For example, some jurisdictions make explicit reference to a large patient benefit as such a consideration. However, since patient benefit is part of a cost-effectiveness assessment it is not clear how to balance considerations of greater patient benefit against considerations of severity and cost-effectiveness. The aim of this paper is to explore the role of a large patient benefit as an independent criterion for priority setting in a healthcare system also considering severity and cost-effectiveness. By taking the opportunity cost of new interventions (i.e., the health forgone in patients already receiving treatment) into account, we argue that patient benefit has a complex relationship to priority setting. More specifically, it cannot be reasonably concluded that large patient benefits should be given priority if severity, cost-effectiveness, and opportunity costs are held constant. Since we cannot find general support for taking patient benefit into account as an independent criterion from any of the most discussed theories about distributive justice: utilitarianism, prioritarianism, telic egalitarianism and sufficientarianism, it is reasonable to avoid doing so. Hence, given the complexity of the role of patient benefit, we conclude that in priority practice, a large patient benefit should not be considered as an independent criterion, on top of considerations of severity and cost-effectiveness.

Abstract Image

在确定医疗保健优先事项时,患者受益越大就越好吗?
当考虑在预算有限的医疗保健系统中引入新的干预措施时,根据公平原则确定优先次序至关重要。许多司法管辖区采用多重标准方法,包括严重程度和成本效益等多个不同的考虑因素。这种多重标准方法提出了如何平衡不同考虑因素的问题,以及如何理解它们之间的逻辑或规范关系的问题。例如,一些司法管辖区明确将患者的巨大利益作为考虑因素。然而,由于患者获益是成本效益评估的一部分,如何平衡患者获益与严重性和成本效益之间的关系并不明确。本文旨在探讨在同时考虑严重性和成本效益的医疗保健系统中,将患者的巨大获益作为确定优先次序的独立标准的作用。通过考虑新干预措施的机会成本(即已接受治疗的患者所失去的健康),我们认为患者受益与优先级的确定有着复杂的关系。更具体地说,如果严重程度、成本效益和机会成本保持不变,就不能合理地得出结论,认为应优先考虑患者的巨大收益。由于我们无法从功利主义、优先主义、泰勒平均主义和充足主义等讨论最多的分配正义理论中找到将患者利益作为独立标准的普遍支持,因此避免这样做是合理的。因此,鉴于患者利益作用的复杂性,我们得出结论,在优先实践中,除了考虑严重性和成本效益外,不应将患者的巨大利益作为独立标准。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.30
自引率
4.80%
发文量
64
期刊介绍: Medicine, Health Care and Philosophy: A European Journal is the official journal of the European Society for Philosophy of Medicine and Health Care. It provides a forum for international exchange of research data, theories, reports and opinions in bioethics and philosophy of medicine. The journal promotes interdisciplinary studies, and stimulates philosophical analysis centered on a common object of reflection: health care, the human effort to deal with disease, illness, death as well as health, well-being and life. Particular attention is paid to developing contributions from all European countries, and to making accessible scientific work and reports on the practice of health care ethics, from all nations, cultures and language areas in Europe.
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