What care is 'essential'? What services are 'basic'?
Article Abstract:
Ideally, society should provide everyone with total medical care at no cost. However, this is not possible, which makes a compromise necessary. The concept of having a minimum set of services, consisting of essential care and basic services, available to all seems to be an attractive alternative. Those who want more services could then purchase them. However, deciding what is essential or basic is far from easy. The problem with essential care is that different interventions have different worths, according to benefits, harms, and costs. Cost, although thought by some to be irrelevant to the decision, is in fact the reason that a system must be devised in the first place. If cost were not important, everyone would have access to all care, which is not the case. Value judgments must be made. The question of who should determine the benefits to be provided is explored, and the implementation of a system of 'patient-judges' is discussed. Essential care is just beginning to be defined, and a system for implementing the definition is in the initial phase. Like all experimental designs, this will have strengths, weaknesses, and biases. The system will also require interpretation, which will provide feedback to refine and improve the process. This method does not depend on a particular type of financing, and can be applied to individual interventions. Inherent in this approach is the belief that different levels of care are acceptable, and that these levels can be defined by a very small group of people. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1991
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Applying cost-effectiveness analysis: the inside story
Article Abstract:
The use of cost-effectiveness analysis to better allocate health care resources is illustrated by the experience of Kaiser Permanente Southern California Region, a health maintenance organization. The HMO's medical centers began using low osmolar (nonionic) contrast agents (LOCAs) in 1985, but found their associated costs were increasing. Although LOCAs cause fewer side effects than high osmolar contrast agents (HOCAs), they are more expensive. A task force reviewed the literature on these agents, and also did a cost analysis to see if the money saved by using HOCAs could be better spent on other benefits such as screening for breast and cervical cancer. They found that using HOCAs would cause 40 more severe but nonfatal reactions, but the money saved could prevent 35 deaths from breast cancer, 100 deaths from cervical cancer or 100 heart attacks. They decided to recommend the use of LOCAs only in patients with a high risk of having a reaction.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1992
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