Allocating scarce resources in a publicly funded health system: ethical considerations of a Canadian managed care proposal

Does the South African government have a duty to fund influenza vaccination of adults 65 years and older?

In this paper, we draw on the thinking about solidarity, reciprocity and distributive justice grounded in Afro-communitarian ethics from the Global South to argue for institutions, particularly the South African (SA) government, have a prima facie duty to foster influenza vaccine uptake for adults 65 years and older. Although we focus specifically on the South African government to defend our position, we believe that our argument extends to all governments. Notably, these duties are that the SA government ought to make influenza vaccines freely available for the older adult in both the public and private health facilities, provided financial allocation and their extant relationships allow for this. Further, the SA government has a duty to improve influenza vaccine procurement and availability in the country, preferably through increasing manufacturing capabilities. This paper is intrinsically valuable to promote epistemic justice, thereby contributing toward the decolonization of the global healthcare system. Moreover, this project has social significance in contributing to mitigation efforts against future public health challenges associated with population aging in resource-limited developing African nations, wherein the impact of population transition will be felt most.

Caring Work, Personal Obligation and Collective Responsibility

Studies of workers in health care and the care of older people disclose tensions that emerge partly from their conflicting obligations. They incur some obligations from the personal relationships they have with clients, but these can be at odds with organizational demands and resource constraints. One implication is the need for policies to recognize the importance of allowing workers some discretion in decison making. Another implication may be that sometimes care workers can meet their obligations to clients only by taking collective action.

Nurses’ Ethical Conflicts in Performance of Utilization Reviews

This article describes the ethical conflicts that a sample of US nurse utilization reviewers faced in their work, and also each nurse’s self-reported ethical orientation that was used to resolve the dilemmas. Data were collected from a sample of 97 registered nurses who were working at least 20 hours per week as utilization reviewers. Respondents were recruited from three managed care organizations that conduct utilization reviews in a large midwestern city. A cross-sectional survey design was used to collect demographic data and to ask closed-response, short-answer and open-ended questions. Ethical conflicts reported by nurses were similar across utilization review settings and many were justice orientated. Self-reported ethical orientations were similar across organizations, with beneficence dominating. Implications of these findings are discussed.

A Review of Current Health Care Funding Models

As healthcare expenses grow, concern about how government and private agencies decide to allocate funds for healthcare resources and services also grows. Decisions for healthcare funding are not made arbitrarily but are based on sound ethical principles and practical considerations. This article is a review of 5 ethically based healthcare funding models discussed in the literature that are currently used to justify funding choices. If healthcare professionals and managers are better informed about the ethical reasoning behind funding choices, they could better determine which resource allocation alternatives to support. But where should we spend our resources? Although healthcare professionals have a duty to advocate for all healthcare recipients to receive a fair share of resources, the author concludes that our greater duty as a profession is to the good of society as a whole. Balancing allocation decisions by considering all of the competing healthcare funding models and the ethical bases for them is suggested rather than to advocate too strongly for favored models.