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dc.contributor.authorWilkinson, D
dc.contributor.authorSavulescu, J
dc.date.accessioned2020-12-21T03:39:20Z
dc.date.available2020-12-21T03:39:20Z
dc.date.issued2018-12-01
dc.identifierpii: 10.1007/s10728-016-0337-z
dc.identifier.citationWilkinson, D. & Savulescu, J. (2018). Cost-equivalence and Pluralism in Publicly-funded Health-care Systems. HEALTH CARE ANALYSIS, 26 (4), pp.287-309. https://doi.org/10.1007/s10728-016-0337-z.
dc.identifier.issn1065-3058
dc.identifier.urihttp://hdl.handle.net/11343/257297
dc.description.abstractClinical 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.
dc.languageEnglish
dc.publisherSPRINGER
dc.rights.urihttps://creativecommons.org/licenses/by/4.0
dc.titleCost-equivalence and Pluralism in Publicly-funded Health-care Systems
dc.typeJournal Article
dc.identifier.doi10.1007/s10728-016-0337-z
melbourne.affiliation.departmentMelbourne Medical School
melbourne.source.titleHealth Care Analysis
melbourne.source.volume26
melbourne.source.issue4
melbourne.source.pages287-309
dc.rights.licenseCC BY
melbourne.elementsid1261820
melbourne.contributor.authorSavulescu, Julian
dc.identifier.eissn1573-3394
melbourne.accessrightsOpen Access


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