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The morality of efficiency in health care—some uncomfortable implications


  • A. J. Culyer


There are some general considerations which have implications for the delivery and finance of health care in all countries, not only Canada and the USA. Beginning with two propositions: that access to health care is a right of citizenship, which should not depend on individual income and wealth; and that the objective of health services is to maximise the impact on the nation's health of the resources available; the paper examines the ethical justification for pursuing efficiency in health care provision. The different meanings of efficiency are discussed in detail, and the use of quantitative indicators of health benefit, such as the QALY, placed in context. It is argued that the determination of health care resource allocations should take account of costs at both the macro planning level and the micro level of the individual doctor‐patient relationship. Given the starting points the overall conclusion is that it is ethical to be efficient, since to be inefficient implies failure to achieve the ethical objective of maximising health benefits from available resources.

Suggested Citation

  • A. J. Culyer, 1992. "The morality of efficiency in health care—some uncomfortable implications," Health Economics, John Wiley & Sons, Ltd., vol. 1(1), pages 7-18, April.
  • Handle: RePEc:wly:hlthec:v:1:y:1992:i:1:p:7-18

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    Cited by:

    1. Richter, Anke & Hicks, Katherine A. & Earnshaw, Stephanie R. & Honeycutt, Amanda A., 2008. "Allocating HIV prevention resources: A tool for state and local decision making," Health Policy, Elsevier, vol. 87(3), pages 342-349, September.
    2. Lazaro, Pablo & Azcona, Barbara, 1996. "Clinical practice, ethics and economics: the physician at the crossroads," Health Policy, Elsevier, vol. 37(3), pages 185-198, September.
    3. Shah, Koonal K., 2009. "Severity of illness and priority setting in healthcare: A review of the literature," Health Policy, Elsevier, vol. 93(2-3), pages 77-84, December.

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