Controlling Healthcare Costs: Just Cost Effectiveness or "Just" Cost Effectiveness?
Meeting healthcare needs is a matter of social justice. Healthcare needs are virtually limitless; however, resources, such as money, for meeting those needs, are limited. How then should we (just and caring citizens and policymakers in such a society) decide which needs must be met as a matter of justice with those limited resources? One reasonable response would be that we should use cost effectiveness as our primary criterion for making those choices. This article argues instead that cost-effectiveness considerations must be constrained by considerations of healthcare justice. The goal of this article will be to provide a preliminary account of how we might distinguish just from unjust or insufficiently just applications of cost-effectiveness analysis to some healthcare rationing problems; specifically, problems related to extraordinarily expensive targeted cancer therapies. Unconstrained compassionate appeals for resources for the medically least well-off cancer patients will be neither just nor cost effective.
['Fleck|Leonard M|LM|']
D026688:Bioethical Issues D003362:Cost-Benefit Analysis D017048:Health Care Costs D015276:Health Care Rationing D006801:Humans D019057:Quality-Adjusted Life Years D040841:Resource Allocation D012935:Social Justice
cost-effectiveness healthcare justice targeted cancer therapies medically least well-off National Institute for Health and Clinical Effectiveness (NICE) QALYs bedside rationing equity invisible rationing rule of rescue