matter to design a system that achieves optimal coverage by focusing on treatment types exclusively, without also considering the implication of treatment on the patient. In theory, we could artificially limit the availability of AIDS medication or dialysis machines at some quantity and deny access to anyone who needs assistance after the pre-designated limit is reached, regardless of the various circumstances that become present in such future cases. Such a system would be easy to administer and easy for people to understand. It would also be highly undesirable. It successfully constrains consumption but does so without regard to equity, public health, utility, or any other factor. Additionally, where resources are available, to turn a person away who needs those resources for survival simply because the predetermined rules say so imposes an exceptionally high burden on that individual and should require a compelling justification. The NHS attempted to provide that justification by incorporating a policy factor into their analysis: the interest of increased life expectancy, discounted by the relative quality of that life. In the next Section,100 I will address the use of QALYs and whether it was appropriate to adopt just one factor. I will also address the problems associated with choosing among the various factors that might be used to justify such decisions. In brief, it is doubtful that NHS’s justification is sufficiently compelling to justify the extreme burdens that it imposes.
The experience of the NHS, the adoption of a prio本文来自辣.文,论-文·网原文请找腾讯752018766ritization tool into the quantity scheme, and the story of Elaine Barber demonstrate two additional related points. First, Barber’s initial denial of care was mathematical and automatic. Extraneous factors, such as the needs of her four children and the happiness she might have experienced from raising them (even if from a hospital bed), were irrelevant because they did not increase Barber’s “quality of life,” tautologically defined to exclude extraneous factors that might actually impact on her experienced quality of life. The QALY calculation, just as any priority rationing scheme, draws lines that are not universally agreed upon in order to perform sterilized calculations. Whether Barber should or should not have been entitled to the medication she desired, the fact that the denial issued without due consideration of its immediate implications is very troubling and reflects an objectionable normative decision.
关于简化背包问题的算法源代码
D. RATIONING BY PRIORITIZATION
The most common form of prioritization today is not commonly thought of as a form of prioritization. The method is descriptively known as “first-come, first- served” and is widely condemned by health scholars. Prioritizing those who come first to the hospital or the doctor serves no public health objective. Indeed, it might even be bad public health policy for it generally prioritizes those who are least likely to recover (assuming that the people who come first are those most sick). Moreover, the Centers for Disease Control and Prevention (CDC) has come out against “first-come, first-served” as a method of prioritization for distribution of vaccine against pandemic influenza on distributional grounds. It argued that these prioritizational systems place “certain groups–such as those who are less likely to be informed or those who have inadequate transportation–at a disadvantage.”
This, however, creates potential jurisdictional problems. Were the board to issue a decision in favor of the government on legal grounds, the decision would likely be subject to appeal to the jurisdiction’s civil courts To grant the board jurisdiction over legal issues (such as questions regarding the validity or proper interpretation of the contract and the applicability of intervening state or federal regulation) would be inefficiently duplicative and would tie up the administrative process. It would be more efficient to deny the board jurisdiction over purely legal claims. Further, to expect the adjudicators, who must be proficient in economics, psychology, and health policy, to also be sufficiently proficient in law such that they are able to conduct a trial and conclusively decide issues pertaining to state contract law is probably asking too much. Rather, the adjudicatory board should be permitted to mandate payment by the insurance company only to the extent demanded by equity and the new moral paradigm
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