A. THREE APPROACHES TO RATIONING 算法设计与分析n次全排列源代码
1.Rationing in the United States is accomplished primarily by price. Market-based systems, defined generally, allocate resources to those who are most willing to pay for them. In so doing, those who are unable to pay are priced- out of the market–they are denied access to the goods they desire. Markets thus create an effective means of rationing medical care by excluding certain people from the marketplace, thus limiting consumption against the will of the consumer. This is rationing by price.本文来自辣.文,论-文·网原文请找腾讯752018766
2.Lamm suggested that rationing by quantity (setting limits on access to certain high-cost care by artificially limiting the quantity of that care available for consumption) might be conceptualized as “last-dollar rationing” as opposed to rationing by price, which is “first-dollar rationing.” First-dollar rationing programs prevent access to initial treatment while last-dollar rationing programs focus on limiting access over time. If the purpose of rationing is to maximize public health, controlling total expenditures is more congruous with that objective than is excluding a class of individuals from coverage entirely. Rationing by price grants the wealthy access to procedures that promise little marginal benefit relative to the cost of treatment and excludes the poor from low-cost high-value procedures that undeniably improve both public and individual health. In stark contrast, rationing by quantity favors procedures that maximize public health relative to their costs.
3.Finally, rationing by prioritization attempts to rank patients for treatment according to need or some other rubric, rather than by limiting quantity. Rationing by prioritization and rationing by quantity are closely related, but different. Rationing by quantity focuses primarily on limiting access to certain types of treatment while rationing by prioritization focuses primarily on limiting access for certain types of people. If those people are defined by their medical condition (AIDS patients, for example) the line between rationing by prioritization and rationing by quantity is blurred. There is little functional difference between denying all treatment for AIDS patients (rationing by prioritization) and denying access to AIDS medication (rationing by quantity). The two are nevertheless analytically distinct, deserve separate analysis, and present different problems.
Using prioritization as a rule of exclusion is not analytically simple and the proper construction of such a prioritization scheme is not obvious. The problem is exacerbated because the methods available to policy-makers are nearly infinite. Here are a few potential viable examples, in no particular order: (1) utility (providing access in a manner designed to increase aggregate utility); (2) public health (providing access in a manner designed to increase aggregate public health (which is not necessarily coextensive with utility)); (3) nationality; (4) global productivity (particularly where extended illness or death is likely, we could provide treatment to those who are likely to be most productive after the emergency has past); (5) temporal
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