The economics of health care rationing: an examination of alternative normative claims

Wailoo, Allan (2003). The economics of health care rationing: an examination of alternative normative claims. PhD thesis The Open University.



This thesis examines the economics of health-care rationing as an example of a real and substantive social choice problem. Throughout, it argues that existing approaches to the issue are not normatively appealing because the welfare-economics foundation on which they are based is exclusively consequentialist, that is, alternative states of affairs are assessed solely in terms of consequences. This is evident in health maximisation, one of the most commonly applied approaches to health-care rationing.

Arguments are presented that outline reasons why consequentialism may not be an appropriate philosophical basis for decision-making in health-care and the suitability of alternative non-consequential frameworks is examined. One particular approach to nonconsequentialism, procedural preferences, is then developed in greater detail. It is argued that individuals have preferences for the methods by which decisions are made and that these preferences are derived from the inherent, as well as instrumental, value associated with alternative decision-making mechanisms. A taxonomy of procedural characteristics is developed.

Supporting empirical evidence for each of these sets of arguments is derived from two postal surveys of the UK general public. Triangulation is achieved through a media analysis of UK newspaper reports. The content of reports relevant to health-care rationing were examined and coded in order to identify the frequency with which reference was made to alternative types of claims.

The thesis finds that the preferences of the UK general public in relation to rationing health-care are not adequately described by approaches such as health maximisation that have been commonly employed by economists. A pluralistic approach is advocated that integrates concerns from a variety of frameworks, both consequential and non-consequential in nature.

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