Skip to main content Accessibility help
×
Hostname: page-component-7c8c6479df-hgkh8 Total loading time: 0 Render date: 2024-03-29T15:15:07.147Z Has data issue: false hasContentIssue false

twelve - Ethics and the social responsibility of institutions regarding resource allocation in health and social care: a US perspective

Published online by Cambridge University Press:  22 January 2022

Get access

Summary

Summary

Like people, institutions are social structures that embody history, values, purposes, power and relationships. In the US (United States), health care contexts are defined by the health care seeker's ability to pay for services through insurance payers and by payers making services available through health care providers. Some services are provided by public funds. However, there are many people who are not eligible for any of these programmes who join the ranks of the more than 43 million in the US without insurance (IOM, 2001; Skocpol and Keenan 2005). Although unemployed people are especially vulnerable to being uninsured, many live in working families (IOM, 2001). Moreover, a disproportionate number of uninsured people are in minority ethnic and racial groups, and have very limited or no access to health care (Link and Phelan, 2005; Williams, 2005). Thus institutional structural arrangements have ethical implications because they result in disparate care and services for different populations and place ethical and moral burdens on providers. In this chapter, institutional responsibility regarding resource allocation is explored and discussed. The complexities of the US health care system are examined by describing four contexts of health care delivery, their historical background and the ethical implications of justice. Second, evidence for and examples of disparate health care in different populations are described. Third, the depersonalising effect of institutions on recipients and providers is described. Fourth, recommendations are made for moral institutional responses to these challenges.

Four health care contexts

Almost seven out of every ten people under the age of 65 in the US subscribe to employment-based health insurance purchased through their own or a family member's employment (IOM, 2001). Many who do not fall within this context receive health care through public funds or through charitable arrangements provided by not-for-profit institutions. A context refers not to a setting, but to the social relationships, rules and structural arrangements among interconnected groups within social structures. When health care contexts are defined by health care seekers’ ability to pay for services and insurance companies or health care organisations (HCOs) making services available, four contexts become apparent (see Figure 12.1):

  • 1. Services covered by employer-provided insurance.

  • 2. Services provided by public funds.

  • 3. Charitable services given to the uninsured who do not qualify for private or public funds.

  • 4. Services not covered by insurance that the health care seeker would value enough to pay out of pocket.

Type
Chapter
Information
Ethics
Contemporary Challenges in Health and Social Care
, pp. 169 - 184
Publisher: Bristol University Press
Print publication year: 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×