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Download/Index.Htm [Last Accessed 18 March 2013] Promotor Prof. dr. Guido Pennings Vakgroep Wijsbegeerte en Moraalwetenschap Copromotor Prof. dr. Sigrid Sterckx Vakgroep Wijsbegeerte en Moraalwetenschap Decaan Prof. dr. Marc Boone Rector Prof. dr. Anne De Paepe Alle rechten voorbehouden. Niets uit deze uitgave mag worden verveelvoudigd, opgeslagen in een geautomatiseerd gegevensbestand, of openbaar gemaakt, in enige vorm of op enige wijze, hetzij elektronisch, mechanisch, door fotokopieën, opnamen, of enige andere manier, zonder voorafgaande toestemming van de uitgever. Faculteit Letteren & Wijsbegeerte Laura Capitaine Financial and commodity scarcity in health care A philosophical analysis of prominent coping mechanisms and solutions in selected settings. Proefschrift voorgelegd tot het behalen van de graad van Doctor in de wijsbegeerte 2014 Acknowledgements The writing of a dissertation is a long journey, the completion of which is made possible by the guidance and support of those around one. In this respect, I am indebted to a large number of people. First and foremost, I owe great thanks to Guido and Sigrid for their continuing encouragement. They have provided many valuable, critical inputs into my work. Notwithstanding their busy schedules, they have always made time for me. As such, they have played a key role in the realization of this dissertation. I would also like to give a special mention to the late Prof. Dr. Bob Binstock. During my time at Case Western Reserve University, I had the honor and pleasure of attending his lectures. These sparked my interest into issues relating to aging and the US health care system. The many conversations I had with him on the topic further fueled my curiosity. His wisdom and spirit are sorely missed. I also wish to express my gratitude to Prof. Dr. Xavier Rogiers, Prof. Dr. Ilse Kerremans, Prof. Dr. Eric Mortier, Prof. Dr. Ann Raes, Dr. Patrick Peeters, and Luc Colenbie. They helped me navigate the complexities relating to the medical side of the organ transplantation field. In addition, they provided me with useful research materials. I am also obliged to Prof. Dr. Paul Schotsmans. He took the time to answer my numerous questions concerning the workings of Eurotransplant. He was also so kind as to introduce me to other prominent figures in the field of organ transplantation. I also owe special thanks to several people who invited me to give lectures, for either academic or lay audiences. These include, but are not limited to, Prof. Dr. Pascal Borry, Dr. Roberto Merrill, Dr. Marc Lagaert, Dr. Katrien Devolder, and Dr. Farah Focquaert. I have had the pleasure of being surrounded by many fantastic colleagues. The list is too long to enumerate here. However, I would like to extend my special thanks to Johan, Katrien, Kristof, and An. Throughout the years, my appreciation for Johan has only grown stronger. He has proven to be not only a close colleague, but a true friend. Katrien and Kristof have provided me with useful advice on numerous occasions. In addition, I have had the pleasure of collaborating with them on some papers. I realize v that it must not always have been easy for them to work with a perfectionist. Thus, I thank them for their patience. I greatly appreciate Kristof’s sense of humor. I also have fond memories of light-hearted discussions with Katrien. These provided a welcome distraction from the often lonesome activity of writing. An provided me with useful reading material on organ transplantation and put me into contact with medical staff at University Hospital Ghent. In addition, she was also a valuable brainstorming partner on several occasions. I would also like to thank Gitte for designing the cover of this dissertation and for helping me with the lay-out. I truly cannot imagine having completed this dissertation without the support of my parents, my sister, Yasmin, and Kenneth. Words cannot express how much I value them. They never ceased to believe in my abilities. Our family gatherings were an invaluable source of relaxation and laughter. Although I have been absent from the scene during the past couple of months, I hope to resume these gatherings with greater frequency in the near future. vi Table of Contents Introduction ................................................................................................................................................................................... ................................................................................................ ............................. 111111 0.1 Scarcity in health care ................................................................................................. 13 0.2 Financial scarcity in health care ................................................................................ 14 0.2.1 Rising health care expenditures .................................................................... 15 0.2.2 Rising health care expenditures: positive evolution or crisis? ................. 16 0.2.3 Exploring solutions to the health care cost crisis ....................................... 19 0.2.4 Saying ‘no’ to beneficial health care in the elderly ..................................... 20 0.2.4.1 Reducing supply of beneficial health care in the elderly ............ 20 0.2.4.2 Reducing demand for beneficial health care in the elderly ........ 22 0.2.5 Research questions relating to financial scarcity in health care .............. 24 0.3 Commodity scarcity in health care ............................................................................ 25 0.3.1 ‘Coping mechanisms’ ...................................................................................... 26 0.3.1.1 Eurotransplant ................................................................................... 27 0.3.1.2 UNOS .................................................................................................... 28 0.3.1.2.1 Proposals for a new kidney allocation system ........... 29 0.3.1.2.2 Criticisms of the new kidney allocation system ........ 32 0.3.1.3 Research questions relating to ‘coping mechanisms’ in commodity scarcity ........................................................................... 33 0.3.2 ‘Solutions’ .......................................................................................................... 34 0.3.2.1 Reducing demand .............................................................................. 34 0.3.2.2 Increasing supply ............................................................................... 35 0.3.2.3 Research questions relating to ‘solutions’ to commodity scarcity ................................................................................................ 37 0.4 Overview of research questions ................................................................................. 39 0.5 Structure of the dissertation ....................................................................................... 40 0.6 References ...................................................................................................................... 45 Part 1 Financial scarcity in health care ................................................................................................................................................................................... ................................................................................ .........51515151 Chapter 1 AgeAgeAge-Age ---basedbased rationing: an overview and analysis .................................................................................. 535353 1.1 Introduction .................................................................................................................. 55 1.2 Overview of age-based rationing proposals and their criticisms .......................... 55 vii 1.2.1 Daniels’ prudential lifespan account ............................................................. 55 1.2.2 Callahan’s biographical lifespan account ..................................................... 65 1.2.3 The original fair innings argument ............................................................... 69 1.2.4 The extended fair innings argument ............................................................ 70 1.2.5 Jecker’s capabilities approach to age-based rationing ............................... 75 1.3 Age-based rationing: general criticisms ................................................................... 79 1.3.1 Age-based rationing as a discriminatory policy .......................................... 80 1.3.2 Age-based rationing as a return-on-investment policy ............................. 83 1.3.3 Age-based rationing as a slippery slope........................................................ 83 1.3.4 Age-based rationing as a last resort policy .................................................. 84 1.3.5 Age-based rationing as a myopic view on the cure-care distinction ....... 85 1.3.6 Age-based rationing as a blunt instrument .................................................. 86 1.4 Age-based rationing: a promising route to cost containment in health care? ................................................................................................................................ 87 1.5 Conclusion ..................................................................................................................... 92 1.6 References ...................................................................................................................... 94 Chapter 2 Biogerontology: a promising route to cost containment in health care?care?..................................................................................................................................................................................................................
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