What do theories of social justice have to say about health care rationing?

Abstract

One of the most controversial issues in many health care systems is health care rationing. In essence, rationing refers to the denial of - or delay in - access to scarce goods and services in health care, despite the existence of medical need. Scarcity of financial and medical resources confronts society with painful questions. Who should decide which medicine or new treatment will be covered by social security and on which criteria such decisions must be based? Can age, for example, be justified as a selection criterion? Should decision-making be left to health care policymakers, hospital administrators, or rather, to treating physicians ('bedside rationing')? And finally: is there a role for individual patients? These are difficult questions that suggest the need for transparent and democratic decision-making. In reality, however, the rationing debate occurs in a sub rosa world, based on imperfect information, distorted interpretations of effectiveness, and hidden cost concerns. This book explores these and other questions from various perspectives (medicine, philosophy, ethics, economics, and law). Each of the book's contributors analyzes the debate from a different angle, in search of fair and just rationing decisions.