Philosophy of healthcare

Philosophy of health care refers to the study of topics related to the availability, provision, and distribution of care for the medical needs of society. The study deals with issues such as whether health care is a right and how that right is defined, what constitutes fair access to health care, what is the government's role or responsibility in providing health care, and how are existing health care resources dispensed. As health care costs have climbed and the resulting expenses have put limitations on the care available to a growing number of people, the philosophy of health care has gained increased attention.

Background

Ethics and philosophy have been part of health care since Hippocrates wrote the words of the physicians' oath that bears his name in the fifth century B.C.E. For centuries, ethics and philosophy in health care referred to the private standards, behaviors, and beliefs of the individual healer or physician. These health care providers generally treated anyone who could reach them and negotiated compensation based on what the population of that geographic area could bear.

As health care grew more sophisticated and facilities such as hospitals came into being, the cost of care increased. As costs rose, some people were unable to afford the most up-to-date treatments for illnesses or injuries. By the early part of the twentieth century, the use of newly discovered medications such as penicillin and more advanced surgical procedures further increased the costs associated with health care.

Health insurance came into being to help people afford these costs; in exchange for paying a set amount monthly, a specific list of procedures and health care needs are paid for by the insurer. In 1943, a tax court ruling made the employee benefit of health insurance exempt from the taxes paid for other compensation paid to employees and made health insurance even more desirable. This tax-free status was made law in the 1954 Internal Revenue Service Tax Code, further entrenching employer-provided health insurance as the norm for meeting health care needs in the United States. Experts state that this helped isolate people from the cost of the services they were receiving and is in part responsible for the fact that costs of providing health care are higher in the United States than in other countries. The experts believe that the usual supply-and-demand restrictions that control costs in a capitalist system did not take effect because people were less aware of the cost of the procedures and care they were receiving.

Other countries approached the increased costs associated with developing medical technology in other ways. For example, in some countries the hospitals are owned by the government and medical professionals are government employees. In other countries, the government imposes restrictions on cost increases and implements measures such as bulk purchases of prescription drugs to help control costs.

Overview

Regardless of the way a country or society approaches the increasing costs of health care, there are many philosophical questions to be addressed. Is health a right that should be protected? What is a just society's role in ensuring the health of its citizens? Is there a difference between a right to health and a right to health care?

Where a society decides that there is a responsibility to ensure health and provide health care for its populace, more philosophical questions arise. Decisions must be made as to what constitutes health care, how much of certain treatments or procedures is considered essential to health, and how care is provided for those who do not have the means to pay for it. Issues of equality of access are also addressed in discussions of the philosophy of health care. For example, what does equal access to health care look like when women of childbearing years tend to have greater health care costs than men of the same age group? Does equal access mean everyone receives the same dollar amount for health care, or does it require that everyone get the care needed to restore the best possible health, regardless of cost? Geographic location can also play a role. For instance, a poor person may live in a large city with highly rated hospitals while a wealthy person may live on an isolated ranch far from sophisticated health care; how do situations like this factor into the determination of adequate health care distribution?

Health care philosophy addresses issues of how insurers or other payers determine what procedures should be covered and who has the right to determine the medical necessity of a procedure. For instance, does the physician, the patient, or the payer have the right to say when a person should have a knee replacement or where the procedure should be done? Do a cancer patient's health care rights include an expensive treatment that might extend life for a few weeks or months, or is it more appropriate to use those funds to help other people with a longer life expectancy?

In addition, philosophical discussions of health care address equitable ways to provide funding for these procedures and foster debate about whether the charges for these procedures are fair compensation. The way new drugs and treatments are devised is also a philosophical concern, as some diseases that are seen as more profitable tend to get the attention of health care innovators, while those that affect fewer people often receive less attention and fewer resources; health care philosophy considers the relative fairness of the needs of many versus the needs of a few. It includes the discussion and debate of issues such as reproductive rights related to abortion and fertility, as well as end-of-life concerns. Health care philosophy also explores issues of justice in providing care for citizens versus noncitizens.

Bibliography

Bruce, Anne, et al. "Understanding Philosophy in a Nurse's World: What, Where and Why?" Nursing and Health, vol. 2, no. 3, July 2014, pp. 65–71, www.hrpub.org/download/20140701/NH2-16802412.pdf. Accessed 24 Dec. 2016.

Daniels, Norman. "Justice, Health, and Health Care." Harvard University, www.hsph.harvard.edu/benchmark/ndaniels/pdf/justice‗health.pdf. Accessed 24 Dec. 2016.

Grayboyes, Robert F. "Defying Gravity." U.S. News & World Report, 12 June 2015, www.usnews.com/opinion/blogs/policy-dose/2015/06/12/why-us-health-care-is-so-expensive. Accessed 24 Dec. 2016.

"Justice and Access to Health Care." Stanford Encyclopedia of Philosophy, 11 Feb. 2013, plato.stanford.edu/entries/justice-healthcareaccess/. Accessed 24 Dec. 2016.

Kliff, Sarah. "8 Facts That Explain What's Wrong with American Health Care." Physician for a National Health Program, 3 Sept. 2014, www.pnhp.org/news/2014/september/8-facts-that-explain-what's-wrong-with-american-health-care. Accessed 24 Dec. 2016.

Ruddick, William. "Medical Ethics." New York University, www.nyu.edu/gsas/dept/philo/faculty/ruddick/papers/medethics.html. Accessed 24 Dec. 2016.

Scheunemann, Leslie P. and Douglas B. White. "The Ethics and Reality of Rationing in Medicine." Chest, vol. 140, no. 6, Dec. 2011, 1625–32, National Center for Biotechnology Information, www.ncbi.nlm.nih.gov/pmc/articles/PMC3415127/. Accessed 24 Dec. 2016.

Zaremski, Miles J. "The Ethics and Philosophy of Health Care as A Citizen's Right—a US Perspective." Huffington Post, 21 Nov. 2012, www.huffingtonpost.com/miles-j-zaremski/health-care-reform‗b‗1892221.html. Accessed 24 Dec. 2016.