The problem of discrimination in health care priority setting

JAMA. 1992 Sep 16;268(11):1454-9.


Increasingly stringent fiscal restrictions on the scope of medical services available to patients have resulted in calls for explicit health care priority setting. Several commentators have called for the application of decision-analytic principles to such efforts, which would assign services priority based on the extent to which they produce preferred health outcomes. The Oregon Medicaid exercise is an example of such a process. An important challenge to these utilitarian efforts is the need to avoid discrimination against people with medical disabilities. Both of the key elements entailed by decision-analytic approaches to priority setting--estimation of outcomes and assignment of values to those outcomes--are vulnerable to charges of discrimination, primarily because both the medical outcomes expected in disabled individuals and the values they place on those outcomes may differ from the general public. Priority-setting efforts must proceed carefully to avoid the appearance (and reality) of discrimination.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Civil Rights / legislation & jurisprudence
  • Disabled Persons / legislation & jurisprudence*
  • Ethical Theory
  • Health Care Rationing / legislation & jurisprudence*
  • Health Priorities*
  • Health Services Accessibility*
  • Oregon
  • Patient Selection*
  • Prejudice*
  • Resource Allocation*
  • State Health Plans / legislation & jurisprudence*
  • Treatment Outcome
  • United States