5.3 Resource Allocation QC
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University of Illinois, Urbana Champaign *
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260
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Health Science
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Nov 24, 2024
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pptx
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CHLH 260:
MEDICAL ETHICS
CHLH 260:
MEDICAL ETHICS
ARIEL FREEHILL, MSHA
ARIEL FREEHILL, MSHA
Resource Allocation
Resource Allocation
Lesson Objectives
Lesson Objectives
•
What is rationing?
•
Shortage/allocation examples
•
Organs, medications, disasters
•
Allocation in disasters
•
Types of disasters
•
Triaging
•
“Quality of life” allocation
•
Ethical issues
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“Distribution of any needed thing or
procedure that is in short supply to those
who need it in accord with a set of rules
that assess fair distribution”
“Distribution of any needed thing or
procedure that is in short supply to those
who need it in accord with a set of rules
that assess fair distribution”
University of Washington / Albert R. Jonsen, Ph.D., Kelly A. Edwards, Ph.D. for
https://depts.washington.edu/bhdept/ethics-medicine/bioethics-topics/detail/78
Rationing
Rationing
Organ Transplants
Organ Transplants
•
Organs in short supply
•
Over 100k patients on list
•
Kidney most needed
•
Choosing is supposed to
be “objective”
University of Washington / Albert R. Jonsen, Ph.D., Kelly A. Edwards, Ph.D. for
https://depts.washington.edu/bhdept/ethics-medicine/bioethics-topics/detail/78
https://www.organdonor.gov/learn/organ-donation-statistics
Medication Restrictions
Medication Restrictions
Insulin
•
Original patent for $1
•
2016 – $450
•
1 in 4 diabetics ration or skip
dose
•
2019 – Colorado State and
Cigna cap prices
Belluz, J. (2019, April 3).
The absurdly high cost of insulin, explained
. Vox. Retrieved March 20, 2022, from https://www.vox.com/2019/4/3/18293950/why-is-insulin-so-expensive
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Medication Restrictions
Medication Restrictions
EpiPen
•
Acquired by Mylan in 2007;
cost $57
•
Injector brings in money; drug
costs $1
•
2016 – $500
Willingham, E. (2021, December 10).
Why did Mylan Hike Epipen prices 400%? because they could
. Forbes. Retrieved March 20, 2022, from
https://www.forbes.com/sites/emilywillingham/2016/08/21/why-did-mylan-hike-epipen-prices-400-because-they-could/?sh=44f4bbe3280c
Disaster Types
Disaster Types
Natural Disaster
•
Events causing
great damage
•
Floods,
earthquakes,
hurricanes
Mass Casualty
•
Number exceeds
available resources
•
Needs more than
normally available
https://languages.oup.com/google-dictionary-en/
https://delvalle.bphc.org/mod/wiki/view.php?pageid=89
•
Optimize patient outcomes for greater
number
•
System decides who gets treatment
•
Created in 1846 – John Wilson
•
Uses levels, color coding, protocols
Triaging
Triaging
Frykberg ER. Medical management of disasters and mass casualties from terrorist bombings: how can we cope? J Trauma. 2002;53(2):201-212.
Koenig KL, Cone DC, Burstein JL, Camargo CA. Surging to the right standard of care. Acad Emerg Med. 2006;13(2):195-198.
Lee, C. H. (2010, June 1).
Disaster and mass casualty triage
. Journal of Ethics | American Medical Association. Retrieved March 20, 2022, from https://journalofethics.ama-assn.org/article/disaster-and-mass-casualty-
triage/2010-06
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Colo
r
Priority
Urgency
Red
Priority 1,
T1
Immediate
Yello
w
Priority 2,
T2
Urgent; not
immediate
Gree
n
Priority 3,
T3
Non-urgent; care
eventually
Black
No Priority
Deceased; injuries
too extensive
ee, C. H. (2010, June 1).
Disaster and mass casualty triage
. Journal of Ethics | American Medical Association. Retrieved March 20, 2022, from https://journalofethics.ama-assn.org/article/disaster-and-mass-casualty-triage/2010-06
https://commons.wikimedia.org/wiki/File:Deconference-2002-triage-tag.jpg
“Quality of Life” Allocation
“Quality of Life” Allocation
University of Washington / Albert R. Jonsen, Ph.D., Kelly A. Edwards, Ph.D. for
https://depts.washington.edu/bhdept/ethics-medicine/bioethics-topics/detail/78
•
Appropriate to
divert allocation?
•
Poor quality of life =
unwarranted to use
resources
•
Issue: idea of quality not
the same
Ethical Issues
Ethical Issues
•
Using cost to restrict
access
•
Quality of life to justify
diversion
•
Triaging patients
•
How to decide who gets
what
University of Washington / Albert R. Jonsen, Ph.D., Kelly A. Edwards, Ph.D. for
https://depts.washington.edu/bhdept/ethics-medicine/bioethics-topics/detail/78
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