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Health and Social Justice$
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Jennifer Prah Ruger

Print publication date: 2009

Print ISBN-13: 9780199559978

Published to Oxford Scholarship Online: February 2010

DOI: 10.1093/acprof:oso/9780199559978.001.0001

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Allocating Resources: A Joint Scientific and Deliberative Approach

Allocating Resources: A Joint Scientific and Deliberative Approach

Chapter:
(p.172) 8 Allocating Resources: A Joint Scientific and Deliberative Approach
Source:
Health and Social Justice
Author(s):

Jennifer Prah Ruger (Contributor Webpage)

Publisher:
Oxford University Press
DOI:10.1093/acprof:oso/9780199559978.003.0009

This chapter addresses the question of priority setting for competing needs when resources are scarce. It begins with the broader societal perspective, because fair decisions must balance spending on health with spending elsewhere. Next, it addresses competing claims within the health budget itself. The health capability paradigm involves reasoned consensus on allocating resources, based on scientific and deliberative processes. The paradigm emphasizes a collaborative and participatory approach to decision‐making that reinforces individual health agency, while at the same time evaluating outcomes in terms of their substantive merit. Medical appropriateness and clinical practice guidelines allow creation of evidence‐based, standardized health policy that provides optimal care and a universal benefits package of goods and services that support central health capabilities. The chapter also discusses efficiency concerns, resource allocation and age, setting limits, rationing, and how to address hard cases, such as medical futility and those invoked by the ‘bottomless pit’ objection or differing conceptions of ‘reasonable accommodation’. A framework for combining technical and ethical rationality for resource allocation is developed.

Keywords:   priority setting, societal perspective, health budget, reasoned consensus, resource allocation, evidence‐based health policy, efficiency, ‘bottomless pit’ objection, ‘reasonable accommodation’, medical futility, medical appropriateness, rationing

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