Ethical Priority-Setting in Healthcare during Pandemics: A Comprehensive Analysis and Policy Proposal - Free Essay

Priority setting is a global challenge because the demand for health care exceeds the available resources (Mitton et al., 2019, p.576). Both the funders and the consumers demand greater accountability for the limited resources used to meet the health care goals (Lopez-Casasno & Pellis, 2016). However, during a pandemic, the resources are likely to become limited, and setting priorities means making tragic choices that are ethically justified (Lopez-Casasno & Pellis, 2016, p.364). A lot of frameworks are available for resource allocation, and they provide holistic information that is useful during a pandemic. Yet, while leveraging the framework, it is vital to consider the context, stage of the epidemic, and the type of healthcare resources available. For example, COVID-19 is significantly affecting older adults, and such considerations are essential in shaping resource allocation priorities (Mukherjee, Haycox and Walley, 2017). The pandemic is causing an unprecedented crisis for the present generation.

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The rapid spread of the virus can increase the number of patients and exceed the available health resources (Mitton et al., 2019, p.576). When using ethical guidelines for resource allocations, one should consider the extent to which the resources get depleted in the current context. For example, it is inappropriate to exclude specific populations at the beginning of a pandemic when resources are still available. When the resources become scarce, resource allocation should be guided by holistic ethical principles. Additionally, characteristics of the populations within the nation, such as race and ethnicity, should not affect resource allocation. Hence, the framework adopted should focus on treating people equally. This paper is incarnating, and it will explore relevant issues that policy decision-makers should consider and develop the appropriate priority-setting strategy in India.

Introduction of an Independent Agency to Undertake Priority in Health Care Setting

The government of India recognized the need for health technology assessment (HTA), as a policy tool for resource allocation and priority setting (Lopez-Casasno & Pellis, 2016). The approach integrates health interventions, cost-effectiveness, and ethical considerations that help in identifying the best approach. India is a pluralistic health system with a high percentage of care getting delivered in the private sector (Chalkidou et al., 2016, p.462). The standard of care is heterogeneous, and because of this complexity, the government has dual responsibilities both at the state and central levels (Rao et al., 2018). During the coronavirus pandemic, the government needs to implement governance policies to identify quality health interventions (Mitton et al., 2019, p.575). The use of HTA indicates if the current strategies represent an efficient use of finite resources and which interventions should be prioritized.

Firstly, the use of HTA as an agency will help in the regulation of health care provision (Lopez-Casasno & Pellis, 2016, p.402). The agency provides ground to regulate quality, prices, and allocation of resources in the country (Chalkidou et al., 2016, p.462). Secondly, it provides the basis for deciding who should have priority access to scarce resources (Prinja and Pandav, 2020, p.231). Allocation principles should be justified at every stage of resource scarcity. For example, when there is little scarcity, the allocation of resources such as ventilators is mostly justified by the principle of first-come basis (Chalkidou et al., 2016, p.462). When the resources become scarce, the budget should get justified on the principle of prioritising those most in need (Downey et al., 2017). Hence every stage and the allocation should promote equality (Mitton et al., 2017, p.573). Additionally, multiple principles should get employed within the allocations scheme (Dang and Vallish, 2016, p.138). For example, the allocation of the scheme of PPE might justify the principle of prioritizing frontline healthcare workers.

The fair process of allocating resources should promote different ethical values (Rao et al., 2018, n.p). The public should become aware of the criteria for guiding decision-making (Ray et al., 2020, n.p). Additionally, the decision should not favor any person, meaning all forms of variance, such as corruption should get challenged (Lopez-Casasno & Pellis, 2016). This is because the agency provides a mechanism that integrates evidence on ethics and health inequities into a priority setting that suits the context of a population (Chalkidou et al., 2016, p.462.More so, the use of HTA during the COVID-19 pandemic will help in achieving cooperation and policy convergence. The approach helps in measuring different health interventions compared to other potential alternatives. A review of the literature posits various health programs in India may implement overlapping or similar interventions (Chalkidou et al., 2016, p.462). While each program is laudable in its benefits, HTA helps in enhancing cooperation between the central and state governments.

Ethical Values to Guide Resource Allocation

Different ethical values and principles will play a vital role in the allocation of resources. The stakeholders should identify health priorities certain to local communities and implement action plans focusing on the needs of the community (Emanuel et al., 2020). Community priority setting is efficient when the stakeholders have comprehensive local data. According to my postulation, I think it is necessary to ask the community about the ethical principles that should guide resource allocation. The agency should apply different values to the allocation of resources using a fair process (Pratt et al., 2018). HTA helps in integrating concerns of social justice and equity. The agency implements mechanisms that mitigate health inequities and a priority setting that suits each community. The normative judgment of the agency should underpin every choice made during the assessment process and offer a policy reflection on the values of the society. For example, the assessment may disaggregate the benefits and costs of similar interventions for diverse communities based on equity concerns.

Principles That Should Guide Priority Setting During a Pandemic

Throughout the last decades, it has been challenging to develop holistic principles for priority setting in the healthcare paradigm. In times of COVID-19, the demand for healthcare is higher, and the healthcare system will be weakened by absent or ill staff. If only a small percentage of patients get treated, this may raise distrust in governments and professionals. Additionally, the fear of the pandemic is likely to lead to a panic in the society. Priorities should be set for medical resources that differ in various aspects, such as patient care and vaccination (Chalkidou et al., 2016). Vaccination aims at protecting the population not affected by the virus, therapy should focus on severely ill patients, and antiviral drugs should be used in the early treatment of the patient.

Additionally, it is vital to note the production of the vaccine will not start immediately after the onset of the pandemic. The availability of antiviral drugs will reduce within the first weeks of the epidemic. Equitable fairness and access is a principles that will play a vital role in saving the lives of patients (Chalkidou et al., 2016). The principle mitigates different forms of discrimination, minimizes unfairness, and gives priority to patients who are at a high risk of death. Additionally, accountability is an ethical value that helps the committee members to be held responsible and to justify their decisions.

Implicit and Explicit Rationing

Rationing always takes place because no society has enough resources to meet the needs of the people through statutory funds. However, the rationing process, for the most part, is implicit and does not involve the use of explicit rules of distribution that define how rationing should take place. Implicit rationing occurs at the micro or clinical level. Hence the process of resource allocation occurs at the point of service delivery, and it involves the doctors and the social workers (Suhonen et al., 2018). Governments get involved in resource allocation through different activities such as programs and budget setting. Decisions on priority setting are explicit since it is transparent, although the process does not adhere to the normative rule of distribution (Baltussen et al., 2017). Additionally, macro-level rationing may be pursued by health authorities that have a purchaser function such as Sweden and the United Kingdom (Keliddar, Mosadeghrad and Jafari–Sirizi, 2017). The intention of using technical and normative principles as the critical prism of developing explicit criteria can be used to include or exclude patients from service provision. Hence, the approach is likely to limit the freedom to make decisions for clinicians (Hall et al., 2018). According to my postulation, a combination of both explicit and implicit approaches will help the agency perform better. The approach is useful for those involved under the constraints of resources.

Technical or Due Process Approach

The process of achieving explicitness in priority setting entails the use of technical criteria to make choices among the use of resources. The technical approach entails three structures; evidence-based medicine contributions, the economic, and the epidemiological. Epidemiology focuses on the patterns of morbidity and mortality across age groups, social groups, and geographical areas (Suhonen et al., 2018). The approach gathers information on the leading cause of death, and it helps in determining the needs assessment and prioritizing them on the needs of the society. The economic analysis explores the problem from the perspective of economic cost and benefits of alternative programs.

The approaches to the problem vary in the way the costs and benefits get operationalized and defined (Honigsbaum, 2018). Additionally, the use of evidence-based medicine contribution helps in revealing the relative ineffectiveness and effectiveness of various interventions (Angelis, Kanavos, and Montibeller, 2017). The stakeholders should collect the data for the technical approach. Additionally, the information should be comprehensive to help in achieving the optimal outcomes during the pandemic (Hall et al., 2018). The development of knowledge leads to more practical innovations. In my view, the agency should adopt the technical approach and due process in rationing and priority setting.

The Role of Judgement

Cost-effectiveness analysis helps in addressing concerns of health equity (Callahan, 2018). The CEA is used globally to shape priority settings in public health and health care, but the approach does not provide information about tradeoffs between equity and cost-effectiveness. CEA leverages social value judgment on equity, for example, how to compare costs, which effects and costs to measure, and so forth (Honigsbaum, 2018). A review of the literature postulates CEA helps decision-makers in choosing a cost-ineffective investment that will reduce the cost of health (Kapiriri and Razavi, 2017). The interpretation of opportunity cost can be a problem if a fixed budget does not exist. The agency should adopt the distributional cost-effectiveness analysis (Callahan, 2018). The approach focuses on the distribution of health variables and the opportunity costs from the displaced expenditure (Hall et al., 2018). Additionally, DCEA aggregates effects and values into a common metric. The approach allows for the development of measures of health equity.