Health Care Analysis

, Volume 7, Issue 2, pp 153–165 | Cite as

Ethical Issues in the Economic Assessment of Health Care Technologies

  • Jean-Paul Moatti
Article

Abstract

This paper challenges traditional views which oppose health economics and medical ethics by arguing that economic assessment is a necessary complement to medical ethics and can help to improve public participation and democratic processes in choices about resource allocation for health care technologies. In support of this argument, four points are emphasized: (1) Most current biomedical ethical debates implicitly deal with economic issues of resource allocation. (2) Clinical decisions, which usually respect the Hippocratic code of ethics, are nevertheless influenced by economic incentives and constraints. (3) Economic assessment is concerned with both efficiency and equity and potential trade-offs between the two, which means that ethical judgements are always embedded in welfare economics. (4) The real debate is not between economics on the one side and medical ethics on the other. Rather it is between different ethical conceptions of social justice and the contrasting approaches they entail to reconciling individual interests and preferences with collective goods and welfare.

ethics welfare economics cost-benefit analysis health care technologies 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Arrow, K. (1963) Uncertainty and the Welfare Economics of Medical Care. American Economic Review 5, 941–973.Google Scholar
  2. Auquier, P., Macquart-Moulin, G., Moatti J.P. et al. (1995) Comparison of Anxiety, Pain and Discomfort in Two Procedures of Hematopoietic Stem Cell Collection: Leukacytapheresis and Bone Marrow Harvest. Bone Marrow Transplantation 16, 541–547.PubMedGoogle Scholar
  3. Culyer, A.J. (1989). The Normative Economics of Health Care Finance and Provision. Oxford Review of Economic Policy 5, 34–58.Google Scholar
  4. Evans, R.G. (1974). Supplier-Induced Demand: Some Empirical Evidence and Implications. In M. Perlman (Ed.), The Economics of Health and Medical Care. Amsterdam: North-Holland.Google Scholar
  5. Fleck, L.M. (1994). Just Caring: Oregon, Health Care Rationing and Informed Democratic Deliberation. Journal of Medical Philosophy 19, 367–388.Google Scholar
  6. Harris, J. (1977). The Internal Organization of Hospitals: Some Economic Implications. Bell Journal of Economics 8, 467–482.CrossRefGoogle Scholar
  7. Hartmann, O., Le Ccoroller, A.G., Blaise, D. et al. (1997). Peripheral Blood Stem Cell and Bone Marrow Transplantation for Solid Tumors and Lymphomas: Hematologic Recovery and Costs. Annals of Internal Medicine 126, 600–607.PubMedGoogle Scholar
  8. Haut Comite de la Sante Publique, 1998. Regional Allocation of Resources and Inequities in Health (in french). Paris: Ministère de la Santé.Google Scholar
  9. Hillner, B.E., Smith T.J. and Desch, C.E. (1993). Assessing the Cost-effectiveness of Adjuvant Therapies in Breast Cancer Using Decision Analysis Model. Breast Cancer Research and Treatment 25, 97–105.PubMedCrossRefGoogle Scholar
  10. Jones-Lee, M.W. (Ed). (1982). The Value of Life and Safety. Amsterdam: North Holland.Google Scholar
  11. Kaldor, N. (1939). Welfare Propositions of Economic and Interpersonal Comparisons of Utility. Economic Journal 49, 549–552.CrossRefGoogle Scholar
  12. Little, I.M.D. (1957). A Critique of Welfare Economics. Oxford: Oxford University Press.Google Scholar
  13. Macbeth, H.M. (Ed.) (1996). Health Outcomes. Oxford: Oxford Science Publications.Google Scholar
  14. Macquart-Moulin, G., Viens, P., Bouscary, M.L. et al. (1997). Discordance between Physicians' Estimations and Breast Cancer Patients Self-assessment of Side-effects of Chemotherapy: An Issue for Quality of Care. British Journal of Cancer 76, 1640–1645.PubMedGoogle Scholar
  15. Mooney, G., Hall, J., Donaldson, C and Gerard, K. (1991). Utilisation as a Measure of Equity: Weighing Heat? Journal of Health Economics 10, 383–476.CrossRefGoogle Scholar
  16. Neumann, P.J. and Weinstein, M.C. (1991). The Diffusion of New Technology: Costs and Benefits to Health Care. In Gelinjs, A.C. and Halm, E.A. (Eds.), The Changing Economics of Medical Technology. Washington DC: National Academy Press.Google Scholar
  17. Polaniyi, K. (1957). The Great Transformation: The Political and Economic Origins of Our Time. Boston: Beacon Press.Google Scholar
  18. Protiere, C., Genre, D., Cowen, D. et al. (1997). Elicitation of Preferences and Breast Cancer: Patients' Participation in the Decision-Making Process. European Journal of Cancer 33, S9.CrossRefGoogle Scholar
  19. Redelmeier, D.A. and Tversky, A. (1990). Discrepancy Between Medical Decisions for Individual Patients and for Groups. New England Journal Of Medicine 322, 1162–1164.PubMedCrossRefGoogle Scholar
  20. Rifkin, J. (1998). The Biotech Century: Harnessing the Gene and Remaking the World. New-York: Tarcher & Putnam's Sons.Google Scholar
  21. Rotily, M., Loubiere, S., Nixon, J., Bourliere, M., Halfon, P. and Moatti, J.P. (1997). Socio-Economic Analysis of Various Screening Strategies for Chronic Hepatitis C in a French Population. Gastroentérologie Biologique & Clinique 20, S33–S40.Google Scholar
  22. Sen, A.K. (1974). Rawls versus Bentham: An Axiomatic Examination of the Pure Distribution Problem. Theory and Decision 4, 132–157.CrossRefGoogle Scholar
  23. Tobin, J. (1970). Limiting the Domain of Inequality. Journal of Law and Economics 13, 263–277.CrossRefGoogle Scholar
  24. Tonnaire, G., Paraponaris, A., Chanut, C. and Sambuc, R. (1997). Institutional Structure, Financing Mechanisms and Heterogeneity in Cancer Supply: Experience from 1,078 Breast Cancer Patients in a French Region. European Journal of Cancer 33, S12.CrossRefGoogle Scholar
  25. Udvarheliyi, L.S., Colditz, R.A., Rai, A. and Epstein, A.M. (1991). Cost-Effectiveness and Cost-Benefit Analyses in the Medical Literature. Are the Methods Being Used Correctly? Annals of Internal Medicine 116, 238–244.Google Scholar
  26. Van Doorslaeer, E., Wagstaff, A. and Rutten, F. (Eds).(1993). Equity in the Finance and Delivery of Health Care. An International Perspective. Oxford: Oxford Medical Publications.Google Scholar
  27. Warnock, M. (1994). Some Moral Problems in Medicine. Health Economics 3, 297–300.PubMedGoogle Scholar
  28. Warnock, M. (1998). An Intelligent Person's Guide to Ethics. London: Duckworth & Co. Ltd.Google Scholar
  29. Wennberg, J.E. and Gittelshon, A. (1982). Variation in Medical Care among Small Areas. Scientific American 246, 100–112.CrossRefGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1999

Authors and Affiliations

  • Jean-Paul Moatti
    • 1
    • 2
  1. 1.University of the MediterraneanMarseillesSouth Eastern France
  2. 2.Institut Paoli-Calmettes, Regional Cancer HospitalSouth Eastern France

Personalised recommendations