The allocation of healthcare resources involves distributing health-related materials and services among various uses and people. The concept of allocation can imply that a designated individual or group is responsible for each level of decision making within a system that is designed to distribute fixed amounts of resources. Nevertheless, the degree to which such a system exists and such explicit allocation decisions occur varies widely. In the United States, for example, allocation of resources to and within healthcare has long been more the product of millions of individual clinical decisions and various market forces than the result of an overall social policy. Even in the United States, however, arenas exist where more explicit allocation occurs, such as the U.S. Veterans Health Administration with its Veterans Equitable Resource Allocation System (U.S. Veterans).
Healthcare allocations are commonly classified in terms of two levels of decision making: microallocation and macroallocation. Microallocation focuses on decisions regarding particular persons. It often involves "patient selection": determining which patients among those who need a particular scarce resource, such as a heart transplant, should receive treatment. Sometimes, however, microallocation entails deciding for an individual patient which of several potentially beneficial treatments to provide, particularly when only a limited time is available for treatment.
Macroallocation, on the other hand, entails decisions that determine the amount of resources available for particular kinds of healthcare services. Macroallocation decisions include how particular health-related institutions such as hospitals or government agencies such as the U.S. National Institutes of Health budget their spending (sometimes referred to as mesoallocation). Macroallocation also encompasses the decisions a nation makes concerning what resources to devote to particular institutions or, more broadly, to high-technology curative medicine as opposed to, for example, research or primary and preventive care. The extent to which health is fostered through medical care as opposed to nonmedical interventions such as environmental regulation is also a matter of macroallocation, as is the amount of money, time, and energy a society allocates to the pursuit of health rather than to education, defense, and other activities.
The term rationing is a much less clearly defined term that appears in discussions of macroallocation and microallocation alike. Because the debate over rationing raises issues at the foundation of healthcare allocation, it is the focus of the opening section below. The remainder of this entry discusses substantive standards for judging macroallocation, under three headings: the individual's right to healthcare, the community's responsibility for healthcare, and the importance of efficiency in healthcare.
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