Fair Resource Allocation and Rationing at the Bedside

Hardcover | October 29, 2014

EditorMarion Danis, Samia A. Hurst, Len Fleck

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Health systems need to set priorities fairly. In one way or another, part of this important task will fall to physicians. How do they make judgments about resource stewardship, and how should they do so? How can they make such decisions in a manner that is compatible with their clinical dutiesto patients? In this book, philosophers, bioethicists, physicians, lawyers and health policy experts make the case that priority setting and rationing contribute significantly to the possibility of affordable and fair healthcare and that clinicians play an indispensable role in that process. The book depicts the results of a survey of European physicians about their experiences with rationing and other cost containment strategies, and their perception of scarcity and fairness in their health care systems. Responding to and complementing these findings, commentators discuss why resourceallocation and bedside rationing is necessary and justifiable. The book explores how bedside rationing relates to clinical judgments about medical necessity and medical indications, marginal benefits, weak evidence based medicine, off-label use. The book highlights how comparative studies of healthcare systems can advance more effective and fair bedside rationing through learning from one another. From a practical standpoint, the book offers a number of strategies for health care systems and clinicians to work in tandem to allocate and ration resources as fairly as possible: how to foster more attention to fairness when rationing at the bedside, how to avoid exacerbating health disparitieswhen allocating resources, how to teach about bedside rationing to students, how to discuss rationing more explicitly in the public arena and in the doctor's office.

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Health systems need to set priorities fairly. In one way or another, part of this important task will fall to physicians. How do they make judgments about resource stewardship, and how should they do so? How can they make such decisions in a manner that is compatible with their clinical dutiesto patients? In this book, philosophers, bi...

Marion Danis is Head of the Section on Ethics and Health Policy in the Department of Bioethics in the Clinical Center of the National Institutes of Health and Chief of the Bioethics Consultation Service at the Clinical Center. Her research focuses predominantly on improving the health of disadvantaged populations and on strategies for ...

other books by Marion Danis

Format:HardcoverDimensions:464 pages, 9.25 × 6.12 × 0.98 inPublished:October 29, 2014Publisher:Oxford University PressLanguage:English

The following ISBNs are associated with this title:

ISBN - 10:0199989443

ISBN - 13:9780199989447

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Table of Contents

Marion Danis, Reidun Forde, Leonard M. Fleck, Samia A. Hurst, Anne Slowther: IntroductionPart I. A European Survey of Bedside Rationing1. Samia A. Hurst, Anne Slowther, Reidun Forde, and Marion Danis: The Values at the Bedside Study: Bedside rationing by physicians2. Samia A. Hurst, Reidun Forde, Anne Slowther, and Marion Danis: The interaction of bedside rationing and the fairness of healthcare systems: Physicians' viewsPart II. The Societal Context3. Samia A. Hurst: The Swiss Context4. Anne Slowther: The UK Context5. Reidun Forde: The Norwegian Context6. Renzo Pegoraro and Alessandra Bernardi: The Italian ContextPart III. Analysis of Bedside Rationing7. Tommy Allen, Matt Sutton, and Richard Cookson: How Do Economic Incentive Schemes Influence Rationing Decisions by Primary Care Physicians?8. Keith Syrett: The legal context of bedside rationing9. Michael Barilan: Bedside Rationing or Rational Planning: In Search of Perspective on Medical Benefit and Safety10. Leonard M. Fleck: Just Caring: The Ethics Challenges of Bedside Rationing11. Howard Brody: Overdiagnosis and Overtreatment: Implications for Bedside Rationing12. Daniel Strech and Marion Danis: How can bedside rationing be justified despite coexisting inefficiency? The need for "benchmarks of efficiency"13. Bob Goodin: The Collective Action Problem14. Paul Menzel: Statistical vs. Identifiable Lives: Why Not to Use the R Word15. Vegard Bruun Wyller: Give to The Doctor What is Due to The Doctor! Why 'Fair Rationing at The Bedside' is ImpossiblePart IV. Strategies for Promoting Fair Bedside Rationing16. Odd Soreide, Stener Kvinnsland, and Torhild Heggestad: Priority Setting in Hospital Care: Implementing National Legislation and Guidelines in a Hospital Trust17. Samia A. Hurst and Marion Danis: Rationing by Clinical Judgment18. Jan Schrmann, Barbara Meyer-Zehnder, Marcel Mertz, Heidi Albisser Schleger, Mathias Schlgl, Reto Kressig, Hans Pargger, and Stella Reiter-Theil: Fairness and Transparency in Bedside Micro-allocation: Improving the Ethical Competence of Clinical Staff19. ally Disadvantaged Groups and Health Disparity Populations: Issues and Strategies: Fair Resource Allocation in Clinical Care for Socially Disadvantaged Groups and Health Disparity Populations: Issues and Strategies20. Steven D. Pearson: Bedside Rationing After Health Care Reform in the United States: The Emergence of Accountable Care Organizations21. Ole Norheim: Priority Setting Through Clinical Practice Guidelines: Lessons Learned22. Susan Dorr Goold: Physicians as Bellwethers23. Marion Danis, Greer Donley and Reidun Forde: Moving Away from Silent Trepidation: Changing the Discussion of Rationing and Resource Allocation24. Anne Slowther and Benjamin P Bennett: Priority Setting As a Clinical Skill: How Do We Educate Physicians?Afterword