The individual vs society: resolving the conflict

Article Abstract:

An individual's use of health care can be at odds with society if large amounts of care are used without repayment, since others must then subsidize that use or face loss of the service. The issues of health care costs, benefit from medical services, and service utilization are discussed; the interaction of these issues can pit the individual against society when resources are limited. The pooling of health care funds, such as occurs in private insurance plans, Medicare, or corporate health plans, reduces costs to each individual while relying on each contributor using only his ''fair share'' of the pool. Fair shares can be defined according to the amount of benefit per unit of resource consumed, which should be equitable for all concerned. Two perspectives on resource allocation are outlined: the public health or societal perspective, where decision-makers allocate resources across patients; and the patient's perspective, where decision-makers choose the resources that allow the best care for individual patients. A hypothetical example is presented to illustrate the outcomes for 1,000 female employees, in terms of increased life expectancy and cost, of selecting three health care options for preventing or treating breast cancer (screening, high-dose chemotherapy, or both). The author believes that health care policies formulated from the public health perspective result in more people living longer, with better life quality and at lower cost, than policies formulated from the patient's perspective. This is a consequence of the fact that the public health perspective offers more choices: the patient's perspective is limited to the particular health problems of that patient. However, the current system leads individuals to attempt to obtain as much from society as possible. Three recommendations are made: physicians and patients should understand the limits of patient's- perspective arguments; cost-benefit analyses should be carried out for representative, important health problems and interventions; and services that are overused or underused should be reevaluated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Usage, Laws, regulations and rules, Cost (Economics), Costs (Economics)

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Oregon's methods: Did cost-effectiveness analysis fail?

Article Abstract:

Medicaid is about to undergo revisions in the state of Oregon, and this effort has become the focus of a national debate. Medicaid covers the medical bills for almost all services for those who qualify, but more than one third of those below the federal poverty level, as well as all those near the poverty level who do not have insurance, do not qualify. Oregon's Basic Health Services Act is an attempt to provide state funds to ensure access to basic medical care to the poor, and private funds for those above that level. The plan determines not only who, but what should be covered. Whether the program succeeds will depend on how well it determines what will be covered. If done well, this list could become a model for the nation. The first list contained glaring examples of inconsistencies, such as giving dental caps for pulp exposure a priority on a par with ectopic pregnancy, a rapidly fatal complication of pregnancy. The method of determining priorities was radically altered. It is crucial to find out why this first attempt failed. If it is inherently wrong to rank services, a new approach must be found. If the problems are technical, the revised method must be designed to correct these issues. The argument that a cost-effectiveness analysis is conceptually and fundamentally wrong has been put forth. However, when comparing not services, but volume of services, the inconsistencies disappear. This still leaves problems with defining, for example, net benefit versus duration of the benefit. The problem of the ''Rule of Rescue,'' remains: society places greater value on rescuing a little girl in a well than on saving homeless people dying of pneumonia. It remains to be seen whether the new plan will succeed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Editorial, Evaluation, Control, Oregon, Medicaid

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