Book contents
- Frontmatter
- Contents
- List of tables, figures and boxes
- List of contributors
- one Introduction
- Section 1 Ethics: Research and provision in health and social care
- Section 2 Law, management and ethics in health and social care
- Section 3 Ethics: From the start of life to the end
- Index
- Also available from The Policy Press
twelve - Ethics and the social responsibility of institutions regarding resource allocation in health and social care: a US perspective
Published online by Cambridge University Press: 22 January 2022
- Frontmatter
- Contents
- List of tables, figures and boxes
- List of contributors
- one Introduction
- Section 1 Ethics: Research and provision in health and social care
- Section 2 Law, management and ethics in health and social care
- Section 3 Ethics: From the start of life to the end
- Index
- Also available from The Policy Press
Summary
Summary
Like people, institutions are social structures that embody history, values, purposes, power and relationships. In the US (United States), health care contexts are defined by the health care seeker's ability to pay for services through insurance payers and by payers making services available through health care providers. Some services are provided by public funds. However, there are many people who are not eligible for any of these programmes who join the ranks of the more than 43 million in the US without insurance (IOM, 2001; Skocpol and Keenan 2005). Although unemployed people are especially vulnerable to being uninsured, many live in working families (IOM, 2001). Moreover, a disproportionate number of uninsured people are in minority ethnic and racial groups, and have very limited or no access to health care (Link and Phelan, 2005; Williams, 2005). Thus institutional structural arrangements have ethical implications because they result in disparate care and services for different populations and place ethical and moral burdens on providers. In this chapter, institutional responsibility regarding resource allocation is explored and discussed. The complexities of the US health care system are examined by describing four contexts of health care delivery, their historical background and the ethical implications of justice. Second, evidence for and examples of disparate health care in different populations are described. Third, the depersonalising effect of institutions on recipients and providers is described. Fourth, recommendations are made for moral institutional responses to these challenges.
Four health care contexts
Almost seven out of every ten people under the age of 65 in the US subscribe to employment-based health insurance purchased through their own or a family member's employment (IOM, 2001). Many who do not fall within this context receive health care through public funds or through charitable arrangements provided by not-for-profit institutions. A context refers not to a setting, but to the social relationships, rules and structural arrangements among interconnected groups within social structures. When health care contexts are defined by health care seekers’ ability to pay for services and insurance companies or health care organisations (HCOs) making services available, four contexts become apparent (see Figure 12.1):
1. Services covered by employer-provided insurance.
2. Services provided by public funds.
3. Charitable services given to the uninsured who do not qualify for private or public funds.
4. Services not covered by insurance that the health care seeker would value enough to pay out of pocket.
- Type
- Chapter
- Information
- EthicsContemporary Challenges in Health and Social Care, pp. 169 - 184Publisher: Bristol University PressPrint publication year: 2007