From Needs to Health Care Needs

Abstract

One generally considered plausible way to allocate resources in health care is according to people's needs. In this paper I focus on a somewhat overlooked issue, that is the conceptual structure of health care needs. It is argued that what conceptual understanding of needs one has is decisive in the assessment of what qualifies as a health care need and what does not. The aim for this paper is a clarification of the concept of health care need with a starting point in the general philosophical discussion about needs. I outline three approaches to the concept of need and argue that they all share the same conceptual underpinnings. The concept of need is then analyzed in terms of a subject x needing some object y in order to achieve some goal z. I then discuss the relevant features of the object y and the goal z which make a given need qualify as a health care need and not just a need for anything.

Principles of Need and the Aggregation Thesis

“…For simplicity reasons we shall therefore assume that DTP is a principle for distributing treatments rather than diagnostic measures among patients. 12 This does not, however, commit us to the view, held by some people [e.g. 22], that the problem of priority setting is primarily a problem about what health care interventions that should be funded.…”

“…2 For a discussion about the conceptual structure of needs see e.g. [12,13,27,41,44,45]. some common ground: to give some kind of special normative weight to people who are worse off [24,25].…”

“…Fourth, we assume a conception of health care need according to which need is a graded rather than binary concept [cf. 12,22,24], i.e. that it makes perfect sense to talk about degrees of needs.…”

“…127-134]. 12 The focus on treatments also allow us to exclude research and development of new treatments from the following discussion. 13 Employment of multi-level versions of sufficiency principles has been done by others [see e.g.…”

For the Sake of Justice: Should We Prioritize Rare Diseases?

“…Whether or not a patient group is small or large is such an irrelevant group property and the groups' size or the rarity of the condition should therefore not affect the groups possibilities to treatment… compared to other larger groups… [4] 13,14 The authors explicitly state that this is a consideration of justice: ''when worse cost efficiency foremost is due to… the size of the group to which the patient belongs… there is just cause to… accept a worse cost efficiency'' [4], my italics. More specifically, they are thinking about the formal principle of justice [24], p. 422, saying that if there is no relevant difference between two cases, they should not be treated differently [4].…”