Are Indirect Benefits Relevant to Health Care Allocation Decisions?

Abstract

When allocating scarce healthcare resources, the expected benefits of alternative allocations matter. But, there are different kinds of benefits. Some are direct benefits to the recipient of the resource such as the health improvements of receiving treatment. Others are indirect benefits to third parties such as the economic gains from having a healthier workforce. This article considers whether only the direct benefits of alternative healthcare resource allocations are relevant to allocation decisions, or whether indirect benefits are relevant too. First, we distinguish different conceptions of direct and indirect benefits and argue that only a recipient conception could be morally relevant. We analyze four arguments for thinking that indirect benefits should not count and argue that none is successful in showing that the indirectness of a benefit is a good reason not to count it. We conclude that direct and indirect benefits should be evaluated in the same way.

Innovation as a value in healthcare priority-setting: the UK experience

“…Instead, NICE’s AfR framework is committed to health economic and ethical criteria that constrain the conditions under which HTA committees might recommend new technologies (Rid et al, 2015 ; Rumbold et al, 2017 ). For example, although the extent to which wider societal benefits should be factored in healthcare priority-setting is debated (Brock, 2003 ; Culyer et al, 2018 ; Du Toit & Millum, 2016 ; Linley & Hughes, 2013 ; NICE Citizens Council, 2008 ; Miners, A., Cairns, J., & Wailoo, 2013 ; Shearer, Byford, & Birch, 2017 ), NICE explicitly excludes some of these benefits, such as economic productivity, from its health economic calculations (NICE, 2013a ). Our finding that some HTA committees still cite patients’ improved earning capacity in judging technologies as innovative (NICE, 2015d , e , f ) therefore suggests at least some unwarranted variation in how committees interpret NICE’s policy on innovation.…”

The Case for Valuing Non-Health and Indirect Benefits

“…6 Meanwhile, the opposite view has been defended by Kasper Lippert-Rasmussen and Sigurd Lauridsen 2 and more recently (in the context of indirect benefits) by Jessica du Toit and Joseph Millum. 7 This chapter will defend the view that indirect and non-health benefits should not be given lower priority than direct health benefits, and will do so specifically in the context of priority-setting in global health. Its approach can be conceptualized as a criticism of two existing approaches to health policy, which we call No Consideration and Unequal Consideration:…”

“…First, no consensus exists regarding the purpose of many medical resources. 7 Further, assigning moral weight to purpose seems vulnerable to a variety of reductio ad absurdum arguments. Consider the case of thalidomide, a teratogenic drug initially developed and prescribed as a sedative but later discovered to be a cancer treatment.…”

“…This category comprises benefits "obtained by a third party as a result of the fact that the resource is given to a direct beneficiary," which du Toit and Millum illustrate using the example of dependent children who benefit indirectly from direct health benefits to their parents. 7 We will call this category "recipient-produced benefits." However, du Toit and Millum argue that, even if counting recipient-produced benefits to dependent children disadvantages the childless, not counting (or giving less weight to) such benefits fails to take proper account of children's interests.…”

Should you save the more useful? The effect of generality on moral judgments about rescue and indirect effects

“…Some philosophers argue that medical need is the only proper distributive criterion for medical resources Williams, 1976). However, attending to the needs of some patients rather than others may indirectly produce greater (medical or non-medical) benefits for others, and it is not obvious why these indirect benefits should be ignored (Du Toit & Millum, 2016;Kamm, 1993;Lippert-Rasmussen & Lauridsen, 2010;Mogensen, 2020). We focus on prioritization decisions that involve a choice between saving one of two individuals who may be said to differ in how much they contribute to society: for example, a choice between saving the life of a doctor specializing in a form of life-saving heart surgery that very few people in the world can perform and the life of a person who has been unemployed for a long time and is unlikely to find work within the foreseeable future 1 .…”