Pricing Life : Why It's Time for Health Care Rationing

by Peter A. Ubel, M. D.

• ISBN13: 9780262710091
• ISBN10: 0262710099
• Edition: 1st
• Format: Paperback
• Copyright: 2001-10-01
• Publisher: MIT PRESS

Summary

Although managed health care is a hot topic, too few discussions focus on health care rationing-who lives and who dies, death versus dollars. In this book, physician and bioethicist Peter A. Ubel argues that physicians, health insurance companies, managed care organizations, and governments need to consider the cost-effectiveness of many new health care technologies. In particular, they need to think about how best to ration health care. Ubel believes that standard medical training should provide physicians with the expertise to decide when to withhold health care from patients. He discusses the moral questions raised by this position, and by health care rationing in general. He incorporates ethical arguments about the appropriate role of cost-effectiveness analysis in health care rationing, empirical research about how the general public wants to ration care, and clinical insights based on his practice of general internal medicine. Straddling the fields of ethics, economics, research psychology, and clinical medicine, he moves the debate forward from whetherto ration to howto ration. The discussion is enlivened by actual case studies.

Author Biography

Peter A. Ubel is Assistant Professor of Medicine at the University of Pennsylvania School of Medicine, Senior Fellow at the Leonard Davis Institute of Health Economics, and faculty member at the University's Center for Bioethics

Table of Contents

Series Foreword	ix
Acknowledgments	xi
Introduction	xiii
Cost-Effectiveness and the Controversial Necessity of Health Care Rationing	1	(2)
Rationing According to Cost-Effectiveness: Explicit, Quantifiable, and Unacceptable?	3	(8)
The Politics of Defining Health Care Rationing	11	(20)
The Necessity of Rationing Health Care	31	(16)
The Challenge of Measuring Community Values in Ways Appropriate for Making Rationing Decisions	47	(20)
II How Do People Want to Ration Health Care? Balancing Cost-Effectiveness and Fairness	67	(70)
Cost-Effectiveness and Bedside Rationing: Do Two Wrongs Make a Right?	97	(2)
The Case Against Bedside Rationing	99	(12)
Recognizing Bedside Rationing	111	(14)
Linguistic Confusion about Bedside Rationing	125	(12)
III The Unbearable Rightness of Bedside Rationing	137	(48)
The Future of Cost-Effectiveness Analysis and Health Care Rationing	153	(2)
Future Possibilities for Improving How Cost-Effectiveness Analysis Incorporates Public Rationing Preferences	155	(18)
The Future of Cost-Effectiveness Analysis and Health Care Rationing	173	(12)
References	185	(14)
Index	199