Toplumsal Etik Bağlamında Sağlık Hizmetlerinde Ekonomik Değerlendirmeye Eleştirel Yaklaşımlar

Nowadays, the prolongation of life expectancy, the development of health perception and health technologies that are advancing with each passing day make it more difficult to manage scarce resources. Reports from economic assessments provide evidence-based guidelines in the allocation of scarce resources. Thus, economic evaluations in health services have gained more and more popularity.

Health and illness, life and death are often not just about the individual’s own choices. Applied health policies have a direct impact on the health of individuals. Moreover, attention should be paid to the shift of the allocation of scarce resources towards lifeboat ethics. Decisions taken regarding health services are on a slippery slope and their moral basis should be well known.

Health economics is increasingly having an impact on public policy and has a significant impact on people’s lives. For this reason, when it comes to health services, the control of the economic view becomes even more important. How to distribute resources in health services is one of the controversial areas in the social ethics approach. Economic assessments in health care provide evidence-based information and guides about allocating resources and improving outcomes. The aim of this study is to evaluate the health economy and economic evaluation as one of the pillars that carry it, with a social ethics approach. In this context, different views and criticisms in social ethics debates have been compiled and presented.

Diseases have been a chronic problem in human history. Nowadays, the phenomenon of disease has diversified, health technologies have developed and the share allocated to health has gradually increased. How to distribute limited resources in health services has become one of the most controversial questions. Perhaps the first of the topics discussed is whether there is a need to limit resources. Considering that resources are limited and health problems will be more than these, limiting resources seems inevitable. In the distribution of limited resources, economic evaluations are considered as a guide.

In health services, which can guide decision-making between alternatives, economic evaluations can evaluate costs and results together. The first of the discussions in this section stands out as the problem of quantification. It is thought that there are problems in determining the health effects, or in other words, the utility of the compared alternatives. The concept of utility is associated with phenomena such as alleviating or relieving pain, suffering, and it is thought that these are highly subjective and almost impossible to quantify. The concept of QALY as a health outcome measure focuses on the sum of the QALY value of all individuals and ignores the distribution to individuals. In utility measurement methods, different parameters such as health perceptions and socio-cultural characteristics of the respondents are excluded. This situation has an impact on the total utility and should not be ignored. All resource allocations are made according to the needs approach. The need shaped in economic evaluations is made on the basis of the post-treatment, that is, the last health status. Yet those in the worst state of health are those who most need treatment. In other words, it is emphasized that the need is defined according to the pre-treatment health status.

Another issue is the issue of equity. It is argued that an approach that evaluates the costs and utilities of alternative health services together may ignore a fair distribution. The most efficient systems are not always the fairest systems. In general, it is thought that efficiency should be supported by fairness concerns, which is not the only purpose of resource allocation in health care. When the concept of utility is viewed from the perspective of the principle of justice, it is important to distribute the QALY value to the society as evenly as possible, rather than maximizing the sum of the QALYs.…