Academic journal article Review of Social Economy

Allocating Organ Transplant Services: What Can Be Learned from the United States Experience?

Academic journal article Review of Social Economy

Allocating Organ Transplant Services: What Can Be Learned from the United States Experience?

Article excerpt

The increased demand and costs associated with health care in both the United States and Canada has intensified the need to address complex equity and ethical issues while seeking the optimal distribution of technologically based health care services. This is particularly the case in organ transplantation, where the benefits of this technology are widely known while the supply of organs is scarce. This shortage can lead to inequities in the distribution of such services, where the economically or socially disadvantaged may be denied opportunities for life saving organs due to their lack of political or social influence or ability to pay.

This paper focuses on the issues associated with the increased demand for organ transplantation in the United States, and proposes policy guidelines for improvement in organ procurement and transplantation that are applicable to both the United States and Canada given their proximity, increasingly aged populations, and similar health care resource allocation dilemmas. The paper first describes the performance of the health care systems in the United States and Canada and overviews the complications to implementing the guidelines derived from evaluations of organ transplantations. It then outlines the structure of the U.S. Organ Procurement System, the barriers to organ procurement, and the controversial methods proposed to increase organ supply. Ethical considerations in organ procurement and transplantation are then considered and guidelines are proposed that can improve the efficiency of the organ transplantation system while addressing equity and ethical criteria in a universal paradigm. These proposed guidelines are applicable to both the United States and Canada, in that they serve to more efficiently allocate organ transplant services - especially among the disadvantaged - regardless of health care financing system.

U.S. AND CANADIAN HEALTH CARE ENVIRONMENTS

Overall, Canada appears to be more cost-effective than the United States in health care delivery. In 1991, it spent $2,045 per capita (U.S. dollars) or 9.9 percent of its GDP on health care, while the United States spent $2,868 per capita or 13.2 percent of its GDP on health care (U.S. Bureau of the Census 1993). With lower expenditures, Canadians' life expectancy is similar to Americans' while their infant mortality rates are 25 percent lower than those in the United States (Rosenthal 1993).

Although the Canadian system has demonstrated a capacity to deliver universal, high-quality care for less cost than many Western countries (Iglehart 1986), criticisms of the Canadian system result from its traditional cost-control methods. In Canada, primary care is very accessible, but the availability of advanced technology is limited (Politser 1993). Since user fees and rationing are unacceptable for ideologic reasons, the increased costs of health care affect the development and availability of advanced technology for patients (Chiu 1995). This results in longer patient queues which may result in poorer health outcomes when the procedures are eventually performed.

In terms of training and medical advances, the United States most likely has the best health care in the world. It is also a leader in health care expenditures, with total health care spending projected to increase to 15 percent of GNP by the year 2000 (Cherner 1991). Expenditure increases are mainly due to the increased use of technology and the growing chronic health needs of an aging population.

Criticisms of the U.S. system include the fact that reimbursement systems play a major role in resource allocation. The uninsured are 29 to 75 percent less likely to receive high-cost inpatient procedure and are treated less aggressively (Hadley et al. 1991). Further, 73 percent of surveyed physicians in the United States thought patients' inability to afford treatment is a serious problem compared to 25 percent of physicians in Canada and 15 percent in the former West Germany. …

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