This blog is the first part in our series on the allocation of healthcare resources.
The spread of COVID-19 in the United States has caused many to think more critically about the state of healthcare in the United States. While the topic of healthcare has always been a hot topic, the pandemic has brought a sense of urgency to the issue. The current national guideline of social distancing aims to decrease the distribution curve of this pandemic. Without these precautions, there is a real danger that the spread of the virus will exponentially increase. If the number of infected people increases, then there will be an inevitable strain on the healthcare system. There will not be enough equipment and workforce power to take care of all those in need of medical help.
In such situations, difficult choices will have to be made. Some of these choices will be on the allocation of healthcare resources and deciding who will utilize these services and who won’t. This is a form of rationing, which refers to how goods and services are distributed among a population based off certain characteristics.
These characteristics can be based on socioeconomics factors, lifestyle, health status, and other personal attributes. Rationing in healthcare may sound harsh, but it happens even in non-catastrophic situations. An example are liver transplants: due to the shortage of these organs, individuals who have a history of alcohol or drug abuse may be denied access. These organs will be prioritized for individuals who have a higher chance of survival in the future. In other words, individuals that will have a better quality of life and a higher quantity of life. Another form of rationing are healthcare systems that cater to specific populations, such as the VHA.
The main factors of determining allocation of healthcare resources are centered on measuring the quantity and quality of life of an individual. Quantity of life refers to how long a person is projected to live based on their health status and demographic. Quality of life refers to how valuable their current and remaining life will be. Quantity of life for a population can be objectively measured, there is data on the average life span of individual groups based on race, gender, and socioeconomic status. However, even with this data, it can be difficult for any healthcare professional to estimate how long an individual will live. Determining quality of life is as troublesome, as this is a subjective measure. Without information on how an individual values life, making a judgment on quality of life becomes opinion based. For example, death can be seen for many to be the worst case scenario. However, some individuals may argue that this is not the worst fate – and that not being alive is preferable to being paralyzed or in a coma.
However flawed these notions are, quality and quantity of life are the concepts that are used to determine allocation of resources. The next few blogs will discuss the ethics of allocation deeper.