C. RATIONING BY QUANTITY
操作系统进程调度源代码 At the end of the prior Section, I mentioned the private health insurance market in the United States and described it as a contractual form of rationing by quantity. To simplify my discussion about rationing by quantity, I will focus my discussion here on centralized rationing by government officials. Rationing by detached corporate executives is similar to rationing by detached government officials, with the caveat that corporate executives are primarily regulated by market forces while government bureaucrats are primarily regulated by political forces. The distinction between those differing forces and influences are worthy of comment. But for the purposes of this paper, contract-based rationing by quantity is sufficiently similar to centralized rationing.本文来自辣.文,论-文·网原文请找腾讯752018766
The very practice of setting central limits on health care delivery removes medical decision-making from the hands of physicians and patients and places it in the hands of detached officials. The significance of this critique might not be apparent to many, particularly after reading my critique on rationing by price in the prior Section. Indeed, it is far from obvious that putting government officials in control of medical allocation is worse than extreme price rationing. The primary problem with centralized rationing of this kind stems from the fact that decisions are centralized and thereby bureaucratic. Allocators in that context attempt to achieve the best results for the population they service, generally with little regard for the implications of those decisions in individual cases. I believe that it is this detached nature of all quantity rationing programs (whether by the government, insurance companies, or any other power broker) that renders such rationing programs the object of public vitriol and condemned as morally objectionable.
Extreme rationing by quantity imposes significant deficiencies in vertical equity. Vertical equity essentially demands differential treatment for those patients who are who are materially different from each other. A health care delivery system that does not make such distinctions and accordingly denies access to two people by defining them to be in the same class, despite dramatic and relevant differences between them, violates the principle of vertical equity. Failure to distinguish between two distinguishable people can be the fault of a rationing scheme that is not sufficiently nuanced but is more likely the function of a necessary feature of centralized rationing. A rationing scheme that is designed to operate at the level of government without case-by-case oversight would need to be infinitely complex in order to be sensitive to all relevant factors as they present themselves in individual cases. A scheme that approaches infinite complexity would be very difficult and expensive to develop and clearly not worth the costs. Out of necessity, any scheme actually adopted would fail to make morally necessary distinctions. Just as with price rationing, this problem can be avoided by inserting a layer of oversight–a safety valve–into the quantity rationing scheme.
Perhaps all regulatory standard setting suffers from violations of vertical equity. On the surface, my critique thus proves too much. I think the critique is nevertheless justified considering the nature of the regulatory decisions in question. When a decision quite literally means the difference between life and death, the stakes are higher and the need for equity is as well.
操作系统作业调度 NHS’s incorporation of priority rationing (via QALY analysis) into a quantity rationing scheme is not the result of happenstance. It is very difficult as a practical
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