BIOE 5650 Rationing & Resource Allocation

You have one liver but three patients awaiting a liver transplant. Who should get the liver? What criteria should be used to select the recipient? Is it fair to give it to an alcoholic? These are some of the questions that arise in the context of rationing and allocating scarce health care resources among particular individuals, and concern what are called micro-allocation decisions. But trade-offs also need to be made at the meso- and macro-level. Budgets of public payers of healthcare, such as governments, and of private ones, such as health plans, are limited: they cannot cover all drugs and services that appear beneficial to patients or physicians. So what services should they provide? Is there a core set of benefits that everyone should be entitled to? If so, by what process should we determine these? How can we make fair decisions, if we know from the outset than not all needs can be met? Using the cases of organs for transplantation, the rationing for vaccines in a flu pandemic, and drug shortages, the course will critically examine alternative theories for allocating scarce resources among individuals. Using both the need to establish priorities for global health aid and to define an essential benefit package for health insurance, the course will critically examine diverse theories for allocation decisions, including cost-effectiveness analysis, age-based rationing and accountability for reasonableness.