PHC

As the textbook states, health policy goals try to accomplish: Equity/access; quality; and cost-containment. These goals are shaped and challenged by cultural, political, and institutional contexts. With regard to quality, there lies the difficulty in implementing an objective definition. With regard to cost-containment, the overall challenge is maintaining quality under restrictive budgets.

I also agree on the text’s indication that basic level of care should consist of only primary care and not high-tech, in order to contain costs, ensure universal coverage, and assure quality care.

Inevitably, within the US, the clear barriers toward equitable provisions and utilization of multi-tiered services are contingent upon the very fabric of our market-based society; such that, (as stated in Ch. 4): all decisions made by consumer; the consumer must know value of goods; and, the consumers must pay full cost and receive full value.

To discuss the distribution of equitable primary, secondary and tertiary care (or, the prevalence of one type of care over the other), we must consider rationing. Since, even with the equitable allocation of funds and resources to the varying type of care, there will still exist rationing at the micro-allocation level. Furthermore, the difference between health care and medical care adds to the difficulties of proper promotion of health. While the former tries to restore the capacity for integrative functioning, the latter restores physiological and psychological functioning.

Having said that, with regard to which type of care should be given more priority (or, even equitable consideration across the board), we must discuss the clear distinction made between benefits and necessities to further attack the problem of rationing. In other words, are all procedures, surgeries, and services which seem beneficial also considered necessary? Ultimately, there are three types of need. The normative needs are ones that the medical experts (physicians) deem significant. The felt needs are ones that the person feels he needs them (i.e., he wants or desires it). And, the expressed needs are when the felt needs are actually taken into action (i.e., they are placed on waiting lists). (Culyer, 1997).

Another approach is to give scarce resources based upon a priority system where individuals who have most to gain as compared to their pre-operative state, should be awarded the help.

Coming back to the principle of equality, does this mean that people should have equal chances for the best treatments? Apparently this can’t be the case since there aren’t unlimited resources. As a result, it would be that people have the same rights to receive services of the same quality. But, the problem becomes, how can we measure the quality of the different treatments used for different illnesses? It would be hard to categorize such illnesses and deciphering their quality of treatments.

Since personal needs are subjective, and, by focusing on medical needs (which are still representing arbitrary good and ill health bestowed upon the patients), the fact that we would be restoring a patient’s normal range of opportunities (since every person at least has the right for “human functioning” even if not “optimal”) shouldn’t be overridden by the need to gain more QALYs by the patient who is “better off.”

Taking everything into consideration, I do agree that there is a need for the equitable provision of a multi-tiered program of services, targeting various stages of health and medical care needs. There shouldn’t be an overemphasis of one form of care over another, since they are all inter-dependent determinants of health outcomes. It is a matter of whether or not the distribution of equitably allocated resources will be just, or unjust.


Culyer, A.J. Being Reasonable About The Economics of Health. Lyme: Edward Elgar, 1997.