Healthcare Technologies under
Empirical Scrutiny: Assessment of Availability and other Ethical Aspects in Selected Technologies
in Czech Circumstances
KŘÍŽOVÁ E.1, ŠIMEK J.1, MALINA A.2, GRUNDOVÁ D.1, TRČKOVÁ M.1
1Ústav lékařské etiky 3. LF UK, Praha, přednosta doc. MUDr. J. Šimek, CSc. 2Škola veřejného zdravotnictví, IPVZ, Praha, ředitel MUDr. A. Malina, CSc. |
|
Summary:
The paper deals with the problem of „rationing“ expensive care which is connected with the
necessity of selecting patients because it is not possible to provide that care to all of the patients
who could be clinically benefited by it, be it for insufficient capacity of the facility, financial or
other reasons. In a series of interviews with the heads of selected departments providing
super-specialized healthcare there has been discussed the current situation from the point of
view of changes connected with the transformation of healthcare with special emphasis on the
impact of changes in financing since 1997. Further, there has been discussed the problem of
selecting patients, the transparency of allotting care and the interference of non-clinical aspects
into the process of that allotting. The providing of healthcare proceeds on the basis of applying
explicit as well as implicit criteria.Among the explicit ones it is first of all clinical characteristics
that assert themselves. Except for minor exceptions the situation at the time of the survey (year
2000) was assessed positively from the point of view of rationing, without any marked signs of
disproportions between clinical need and available capacities. Such evaluations are probably
influenced to a large degree by continual comparisons of current possibilities with the situation
preceding the year 1989, however, it cannot be ruled out that the need of super-specialized
healthcare is very under-dimensioned due to bad coordination of services at lower levels of the
healthcare system and the „holding up“ of patients in primary and out-patient specialized care.
Key words:
modern technologies - costs - rationing - explicit and implicit rationing.
|