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Ethics and Efficiency in the Provision of Health Care

Published online by Cambridge University Press:  08 January 2010

Alan Williams
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Extract

1.1. A major purpose in nationalizing the provision of health care in the UK was to affect its distribution between people, and, in particular, to minimize the impact of willingness and ability to pay upon that distribution. It has never been clear, however, what alternative distribution rule is to apply. There is no shortage of rhetoric about ‘equality’ and ‘need’, but most of it is vacuous, by which I mean it does not lead to any clear operational guidelines about who should get priority and at whose expense. The closest we have got so far to such explicit guidelines has been the formulae which determine the geographical distribution of NHS funds, the driving force behind which is a notion of need based on relative mortality rates and on the demographic structure. The avowed objective is to bring about equal access for equal need irrespective of where in the UK you happen to be.

Type
Papers
Information
Royal Institute of Philosophy Supplements , Volume 23: Philosophy and Medical Welfare , March 1988 , pp. 111 - 126
Copyright
Copyright © The Royal Institute of Philosophy and the contributors 1988

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References

1 For a fuller discussion of these issues see: Daniels, N., ‘Equity of Access to Health Care: Some Conceptual and Ethical Issues’, Millbank Memorial Fund Quarterly 60 (1982)Google ScholarPubMed; West, P. A., ‘Theoretical and Practical Equity in the NHS in England’, Social Science and Medicine; 15 (1981), 118Google Scholar; Paton, C., ‘The Policy of Resource Allocation and Its Ramifications: A Review’, Nuffield Provincial Hospitals Trust Occasional Paper, No 2 (1985)Google Scholar; Birch, S. and Maynard, A., ‘The RAWP Review’, Centre for Health Economics, Discussion Paper 19 (University of York, 1986).Google Scholar

2 A point made earlier by others, e.g. Steele, R., ‘Marginal Met Need and Geographical Equity in Health Care’, Scottish Journal of Political Economy 28 (1981)CrossRefGoogle Scholar; Mooney, G. H., ‘Equity in Health Care: Confronting the Confusion’, in ffective Health Care I (1983)Google Scholar; de Jong, G., and Rutten, F. F. H., ‘Justice and Health for All’, Social Science and Medicine 17 (1983), 1091.CrossRefGoogle ScholarPubMed

3 See Kind, P., Rosser, R. and Williams, A., ‘Valuation of Quality of Life: Some Psychometric Evidence’, in Jones-Lee, M. W. (ed.), The Value of Life and Safety (North-Holland, 1982)Google Scholar; Williams, A., ‘Economics of Coronary Artery Bypass Grafting’, 291 (1985), 326–329Google ScholarPubMed; Harris, J. Journal of Medical Ethics (forthcoming, 1987).Google Scholar

4 For further details see Wright, Stephen J., ‘Age, Sex and Health: A Summary of Findings from the York Health Evaluation Survey’ Discussion Paper 15 (Centre for Health Economics, University of York, 05 1986)Google Scholar. The full dataset from this survey has been lodged with the ESRC Survey Research Archive and is available there for secondary analysis by interested researchers.

5 See Williams, Alan, ‘Need as a Demand Concept (with special reference to health)’, in Culyer, A. J. (ed.), Economic Policies and Social Goals (Martin Robertson, 1974), 60–76.Google Scholar

6 Wiggins, D. and Dirmen, S., ‘Needs, Need, Needing’, Journal of Medical Ethics 13 (1987), 63–68CrossRefGoogle ScholarPubMed, make a similar point when they concur in E. D. Watts view that ‘it can make good sense to speak of needs without implying any active obligation on the part of any person to meet these needs’.