Health Care Need: Three Interpretations

Abstract

The argument that scarce health care resources should be distributed so that patients in 'need' are given priority for treatment is rarely contested. In this paper, we argue that if need is to play a significant role in distributive decisions it is crucial that what is meant by need can be precisely articulated. Following a discussion of the general features of health care need, we propose three principal interpretations of need, each of which focuses on separate intuitions. Although this account may not be a completely exhaustive reflection of what people mean when they refer to need, the three interpretations provide a starting-point for further debate of what the concept means in its specific application. We discuss combined interpretations, the meaning of grading needs, and compare needs-based priority setting to social welfare maximisation.

Principles of Need and the Aggregation Thesis

“…But benefits accruing to the worst off may not be outweighed by benefits accruing to the best off. 15 DTP prohibits this kind of tradeoff, and accordingly prescribes absolute priority to the worst off over the best off.…”

“…16 Moreover, it seems that the constraint that DTP establishes on certain kinds of aggregation is achieved quite non-arbitrarily and clearly. Although it may be vague, uncertain, and to some extent arbitrary exactly where to set the threshold between 15 Following Crisp here, we assume that these benefits are non-trivial. 16 In Official Norwegian Reports [31] it is also differentiated between three groups of severity.…”

“…ARC aggregates claims whose strength is dependent on (a) the increase in well-being, and (b) the level of well-being from which this increase takes place [43]. Need-based claims are also dependent on (a) and (b) but the interpretation of (b) is different: need-based claims are best understood as non-comparative as they are based on people's absolute levels and have an independent standing of the relation to other people's needs [15,16]. Therefore, while need principles may be plausibly specified in terms of a concern for the worse off (the priority view) as well as sufficiency principles, the idea that need is about the strength of claims in relation to the strongest competing claim seems counterintuitive.…”

“…Principles of need are commonly discussed and employed in health care priority setting [7,15,16,21,22,26,28,35,37,40]. Although need principles may be interpreted in various ways, they all ascribe some special normative importance to being badly off [24,25].…”

Mellom samfunnsstrukturer og profesjon: om avgrensning, kultivering og premisser for adekvat skjønnsutøvelse i legerollen

“…Grimen og Molander gir en nyansert fremstilling av hvordan skjønn tenkes å fungere ved medisinske vurderinger av intervensjoner med et kurativt formål. Behov for helsehjelp kan beskrives på formen tilstandbehandling (Hasman et al 2006). Den samme relasjonen mellom tilstand og behandling kan også bli lagt ut som et hypotetisk imperativ for medisinsk handling med kurativt formål (Grimen & Molander 2008).…”