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Cost-equivalence and Pluralism in Publicly-funded Health-care Systems

Clinical guidelines summarise available evidence on medical treatment, and provide recommendations about the most effective and cost-effective options for patients with a given condition. However, sometimes patients do not desire the best available treatment. Should doctors in a publicly-funded heal...

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Detalles Bibliográficos
Autores principales: Wilkinson, Dominic, Savulescu, Julian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208988/
https://www.ncbi.nlm.nih.gov/pubmed/28062971
http://dx.doi.org/10.1007/s10728-016-0337-z
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author Wilkinson, Dominic
Savulescu, Julian
author_facet Wilkinson, Dominic
Savulescu, Julian
author_sort Wilkinson, Dominic
collection PubMed
description Clinical guidelines summarise available evidence on medical treatment, and provide recommendations about the most effective and cost-effective options for patients with a given condition. However, sometimes patients do not desire the best available treatment. Should doctors in a publicly-funded healthcare system ever provide sub-optimal medical treatment? On one view, it would be wrong to do so, since this would violate the ethical principle of beneficence, and predictably lead to harm for patients. It would also, potentially, be a misuse of finite health resources. In this paper, we argue in favour of permitting sub-optimal choices on the basis of value pluralism, uncertainty, patient autonomy and responsibility. There are diverse views about how to evaluate treatment options, and patients’ right to self-determination and taking responsibility for their own lives should be respected. We introduce the concept of cost-equivalence (CE), as a way of defining the boundaries of permissible pluralism in publicly-funded healthcare systems. As well as providing the most effective, available treatment for a given condition, publicly-funded healthcare systems should provide reasonable suboptimal medical treatments that are equivalent in cost to (or cheaper than) the optimal treatment. We identify four forms of cost-equivalence, and assess the implications of CE for decision-making. We evaluate and reject counterarguments to CE. Finally, we assess the relevance of CE for other treatment decisions including requests for potentially superior treatment.
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spelling pubmed-62089882018-11-09 Cost-equivalence and Pluralism in Publicly-funded Health-care Systems Wilkinson, Dominic Savulescu, Julian Health Care Anal Original Article Clinical guidelines summarise available evidence on medical treatment, and provide recommendations about the most effective and cost-effective options for patients with a given condition. However, sometimes patients do not desire the best available treatment. Should doctors in a publicly-funded healthcare system ever provide sub-optimal medical treatment? On one view, it would be wrong to do so, since this would violate the ethical principle of beneficence, and predictably lead to harm for patients. It would also, potentially, be a misuse of finite health resources. In this paper, we argue in favour of permitting sub-optimal choices on the basis of value pluralism, uncertainty, patient autonomy and responsibility. There are diverse views about how to evaluate treatment options, and patients’ right to self-determination and taking responsibility for their own lives should be respected. We introduce the concept of cost-equivalence (CE), as a way of defining the boundaries of permissible pluralism in publicly-funded healthcare systems. As well as providing the most effective, available treatment for a given condition, publicly-funded healthcare systems should provide reasonable suboptimal medical treatments that are equivalent in cost to (or cheaper than) the optimal treatment. We identify four forms of cost-equivalence, and assess the implications of CE for decision-making. We evaluate and reject counterarguments to CE. Finally, we assess the relevance of CE for other treatment decisions including requests for potentially superior treatment. Springer US 2017-01-06 2018 /pmc/articles/PMC6208988/ /pubmed/28062971 http://dx.doi.org/10.1007/s10728-016-0337-z Text en © The Author(s) 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Article
Wilkinson, Dominic
Savulescu, Julian
Cost-equivalence and Pluralism in Publicly-funded Health-care Systems
title Cost-equivalence and Pluralism in Publicly-funded Health-care Systems
title_full Cost-equivalence and Pluralism in Publicly-funded Health-care Systems
title_fullStr Cost-equivalence and Pluralism in Publicly-funded Health-care Systems
title_full_unstemmed Cost-equivalence and Pluralism in Publicly-funded Health-care Systems
title_short Cost-equivalence and Pluralism in Publicly-funded Health-care Systems
title_sort cost-equivalence and pluralism in publicly-funded health-care systems
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208988/
https://www.ncbi.nlm.nih.gov/pubmed/28062971
http://dx.doi.org/10.1007/s10728-016-0337-z
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