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"Health care rationing"
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Law, legitimacy and the rationing of healthcare : a contextual and comparative perspective
Dr Keith Syrett argues for a reappraisal of the role of public law adjudication in questions of healthcare rationing. As governments worldwide turn to explicit rationing strategies to manage the mismatch between demand for and supply of health services and treatments, disappointed patients and the public have sought to contest the moral authority of bodies making rationing decisions. This has led to the growing involvement of law in this field of public policy. The author argues that, rather than bemoaning this development, those working within the health policy community should recognise the points of confluence between the principles and purposes of public law and the proposals which have been made to address rationing's 'legitimacy problem'. Drawing upon jurisprudence from England, Canada and South Africa, the book evaluates the capacity of courts to establish the conditions for a process of public deliberation from which legitimacy for healthcare rationing may be derived.
eBook
Drawing the line : healthcare rationing and the cutoff problem
Rosoff \"discusses how to decide what should and should not be covered in a generous [health care] benefits plan for all. He considers a variety of ways this might be done and concludes that the most just approach is to utilize a transparent process in which experts and lay people develop a consensus on what should be covered by focusing on both clinical evidence of need and the effective and appropriate means to address those needs. He also considers the various objections and impediments to this proposal and concludes that they are obstacles that can be successfully met\"--Amazon.com.
Book
Can We Say No?: The Challenge of Rationing Health Care
Over the past four decades, the share of income devoted to health care nearly tripled. If policy is unchanged, this trend is likely to continue. Should Americans decide to rein in the growth of health care spending, they will be forced to consider whether to ration care for the well-insured, a prospect that is odious and unthinkable to many. This book argues that sensible health care rationing can not only save money but improve general welfare and public health. It reviews the experience with health care rationing in Great Britain. The choices the British have made point up the nature of the options Americans will face if they wish to keep public health care budgets from driving taxes ever higher and private health care spending from crowding out increases in other forms of worker compensation and consumption. This book explains why serious consideration of health care rationing is inescapable. It also provides the information policymakers and concerned citizens need to think clearly about these difficult issues and engage in an informed debate.
eBook
The Myth of the Workforce Crisis. Why the United States Does Not Need More Intensivist Physicians
Intensivist physician staffing is associated with lower mortality in the intensive care unit (ICU), yet many ICUs are not staffed by trained intensivists. This gap has led to a number of proposals intended to increase the intensivist supply in the United States. In this perspective we argue that such efforts would be both ineffective and ill-advised. Because many ICU patients are not critically ill, workforce models that base demand projections on ICU admission rather than true critical illness substantially overstate the workforce gap. Even in the presence of a workforce gap, training new intensivists would not place them in hospitals where they are needed most, would not mitigate the shortage of nonphysician critical care providers, and would require a unrealistic increase in spending on physician training. In addition, efforts to train more intensivists require us to prioritize intensive care over other specialties that are also in short supply, without clear justification for why intensivists are more important. Rather than continuing an unwarranted push to increase the intensivist supply, we suggest alternative workforce policies that emphasize novel interprofessional care models (to improve ICU quality in the absence of intensivists) combined with limitations on the future growth of ICU beds (to reduce demand through implicit rationing of care). These policies offer opportunities to reduce the mismatch between critical care supply and demand without an unnecessary expansion of the intensivist supply.
Journal Article
Rapid response to the COVID-19 pandemic: Vietnam government’s experience and preliminary success
The COVID-19 pandemic has hit all corners of the world, challenging governments to act promptly in controlling the spread of the pandemic. Due to limited resources and inferior technological capacities, developing countries including Vietnam have faced many challenges in combating the pandemic. Since the first cases were detected on 23 January 2020, Vietnam has undergone a 3-month fierce battle to control the outbreak with stringent measures from the government to mitigate the adverse impacts. In this study, we aim to give insights into the Vietnamese government's progress during the first three months of the outbreak. Additionally, we relatively compare Vietnam's response with that of other Southeast Asia countries to deliver a clear and comprehensive view on disease control strategies.
The data on the number of COVID-19 confirmed and recovered cases in Vietnam was obtained from the Dashboard for COVID-19 statistics of the Ministry of Health (https://ncov.vncdc.gov.vn/). The review on Vietnam's country-level responses was conducted by searching for relevant government documents issued on the online database 'Vietnam Laws Repository' (https://thuvienphapluat.vn/en/index.aspx), with the grey literature on Google and relevant official websites. A stringency index of government policies and the countries' respective numbers of confirmed cases of nine Southeast Asian countries were adapted from the Oxford COVID-19 Government Response Tracker (https://www.bsg.ox.ac.uk/research/research-projects/coronavirus-government-response-tracker). All data was updated as of 24 April 2020.
Preliminary positive results have been achieved given that the nation confirmed no new community-transmitted cases since 16 April and zero COVID-19 - related deaths throughout the 3-month pandemic period. To date, the pandemic has been successfully controlled thanks to the Vietnamese government's prompt, proactive and decisive responses including mobilization of the health care systems, security forces, economic policies, along with a creative and effective communication campaign corresponding with crucial milestones of the epidemic's progression.
Vietnam could be one of the role models in pandemic control for low-resource settings. As the pandemic is still ongoing in an unpredictable trajectory, disease control measures should continue to be put in place in the foreseeable short term.
Journal Article
Disability During a Pandemic: Student Reflections on Risk, Inequity, and Opportunity
As graduate students focusing on disability and public health, some of whom are living with disabilities ourselves, we have seen the COVID-19 pandemic pose great risk to people with disabilities. This is happening not only because of preexisting conditions but also because of the entrenched social inequities people with disabilities face. The initial exclusion of people with disabilities in the US public health response has led to widening disparities, shortcomings in engaging and equitably supporting individuals with disabilities, and practices that devalue the lives of those with disabilities.For example, several states proposed rationing medical care if medical systems became overwhelmed.1 Rooted in ableism (i.e., discrimination in favor of nondisabled people), these plans explicitly singled out people with disabilities and chronic health conditions as members of our community who would not receive health care in times of rationing.1 We hear those without disabilities assure one another notto worry because only those with preexisting conditions are at risk for dying from COVID-19. Furthermore, we are concerned that premature institutionalization of people with disabilities to free hospital beds during the COVID-19 outbreaks has perpetuated disablist practices (i.e., discrimination and prejudice against people with disabilities) and placed the lives of those with disabilities, including our peers, friends, and family, in grave danger.2 During the COVID-19 pandemic, when nursing homes and long-term care facilities are among the deadliest locations, people with disabilities who want to remain in their homes have the right to home- and community-based services.
Journal Article