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1. Unit VIII- Issues of Allocation of Scarce
Health Care Resources
Objectives; At the end of the lesson, the student be
able to:
 Discuss concepts and principles of justice.
 Explain three ways of allocating resources
based on theories of distributive justice.
 Analyze issues and systems of macro
allocation in the health care system.
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2. Concept of Justice
 Justice;
– Broad sense:-describes an ethically correct allocation.
– Narrow sense:-refers to an independent principle of
allocation (having to do with equality or need or merit).
– Giving others what is due to them; Fairness, equitability
and appropriateness of treatment.
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3. What is its importance?
 Nurses and individuals are involved in the health
development and implementation of health policy
in health care.
E.g. Allocation of nursing care and expertise in
hospitals.
 Government constitution says justice- But who is
an advocate for justice in health care?
 Choosing among patients in case of conflicting
demands.
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4.  Principle of justice in the narrow sense
requires taking care of the sickest patient
first, whereas the principle of beneficence
would require giving attention to some
patient who is not as sick but who can be
helped much more.
 How do we decide which patients get scarce
treatments? (Micro-allocation)
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Importance Con’t

5. Three ways to allocate resources-Based on
Theories of Distributive Justice
1. Utilitarianism:-Maximizing net benefits
among action which one do better than
which one harm.
 When trying to decide between two or more
courses of action, the strategy of Utilitarianism
would be to count up the amount of good
each course would do for each person and
subtract the amount of harm it would do.
 Thus producing individual’s net benefit.
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6.  Calculate benefits and harms.
 Principles of beneficence and non-maleficence.
Ex. Keeping promise(duty of fidelity) for one client to
help and do more good on balance by helping
another.
 Conflict between promise and maximizing benefit.
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Utilitarianism Con’t

7. 2. Libertarianism
 Respecting autonomous choices or liberty.
 Libertarians believe that resource should be
allocated according to the free choice of those
who rightfully own or control them.
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8. Libertarianism Con’t
 Everything could be sold to anyone who has
the ability to pay.
 Buyers and sellers should be free to make
whatever bargaining they can.
 Principle of autonomy; Freedom of persons to
make agreement.
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9. 3. Egalitarianism
 Principle of justice- People have a right to
health care.
 Health care should be allocated on the basis of
need,
 Or that increased equality of health status
should be the goal of resource allocation
decision.
 Share the idea of utilitarianism theory of justice.
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10.  There should be equality in justice unless two
conditions are met:
– Inequalities must be to the benefit of the
least well off (i.e. in greatest need).
– There must be equal opportunity for all to
gain from the advantages of treating
people unequally.
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Egalitarianism Con’t

11. Dilemma for discussion
 In case of airplane accident, what should
happen if one of the injured is a physician or
nurse , who can help other injured. Should
rescuers first help the injured health
professional or the most badly injured
passenger?
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12.  Justice permits treating the health care
professional first because even the least well
off will be better off if the health care
professional is given this unequal advantages.
 Maximizes the benefit.
 Satisfies the principle of beneficence.
 Priority rules and not justice.
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Egalitarianism Con’t

13. Major points to choose when deciding how
to allocate time, energy, and other resources
 Maximizing net benefit- principle of
beneficence.
 Freedom of providers and patients to
bargain for whatever they can get-Autonomy.
 Equality of outcomes –Independent
principles of justice.
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14. The Right to Health Care
 Issues- Is there a “right” to health care? If so, Is it
moral right and/or a legal right?
 Two arguments supporting the right to Health Care;
1. Collective social protection
2. Fair opportunity
 The primary dispute among those who argue there
is such a right is based on Beneficence and Right
based on justice.
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15. Allocating Scarce Health Care Resources ?
 Issue: Should the government be involved in health
care allocation and distribution at all, rather than
leaving to marketplace?
E.g. In America every person have health insurance.
 Reasons for Allocation of resources in society;
– Scarcity (demand is greater than supply).
– Material distribution and access issues.
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16. Macro-allocation Decisions???
 How much should be expended? (E.g. In Ethiopia budget for
health is 7%).
 what kinds of goods will be made available?
 How will it be distributed?
 Such decisions are made by parliament, state legislatures, health
organizations and private foundations and others.
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17. Scope and Design of basic Health Care???
System at Macro-level
 What kinds of health care services will exist in
a society?
 Who will get them and on what basis?
 Who will deliver the service?
 How health care fund will be established?
 Who will control how those services will be
distributed?
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18. Problems of Macro-allocation???
 How much budget should be allocated for
health care?
 How much for other social goods such as
housing, education, housing, recreation,
defense, and others?
 Curative versus preventive care.
 These are competing social interests.
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19. Economics of Health Care
 Causes of continually increasing health care costs;
– General inflation based on the overall increase
in consumer price index.
– Population increase.
– Medical inflation.
– New technologies, new procedures, personnel
and other resources;-case study Clinical Vignette
6- A-&B.
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