City Research Online

Abstract

The improvement of health globally is arguably one of the most significant health policy and global strategic issues of the 21st century. What resources should be allocated to improve health and access to health care is contentious. As demonstrated recently by the SARS-CoV-2 pandemic, resource allocation choices are inevitable and those choices are complex, difficult and morally problematic.

Distributive justice, a primary moral concern of health systems, requires that the benefits and burdens of health-related services be prioritized according to morally relevant criteria. Knowing what resource allocation decisions to make would be quite simple if we could agree on both the need to do so and the criteria to guide allocations. However, examination of international experience has shown that there is no consensus about what and how allocation decisions should be made.

The problem of fair allocation of resources is complicated by the fact that in the modern world, the universal humanitarian and caring goals of medicine, as well as the motives of health professionals and policy makers, are being eroded by the pervasive effects of undue faith in economic theory that has driven progressive commercialization of health care, commodification of the human body, and judgments (usually covert) about whose lives are and are not valuable. Trust in physicians and policy makers has been undermined because their work is increasingly seen to be self-serving and directed by market and managerial forces rather than responsive to the needs of individuals and whole populations. Among many different activities needed to promote and preserve professionalism and ensure equity in access to health care, are both a greater degree of moral imagination regarding health disparities and a more rational, ethical and publicly accountable process of allocating resources within and between health systems.

In this article, we examine the current state of knowledge and practice regarding resource allocation at every level of policy making—mega (global), macro (health system), meso (institutional), and micro (clinical program)—and suggest guidance to help decision-makers address these thorny problems.

Publication Type:	Book Section
Additional Information:	Copyright © 2023 Elsevier Inc. All rights reserved.
Publisher Keywords:	Disparities in health, Distributive Justice, Fairness, Global, Health systems, Resources, Sustainability
Subjects:	H Social Sciences > HD Industries. Land use. Labor H Social Sciences > HN Social history and conditions. Social problems. Social reform J Political Science > JZ International relations R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Departments:	The City Law School > International Law and Affairs Group

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