Should Patients Be Allowed to Pay Out of Pocket? The Ethical Dilemma of Access to Expensive Anti-cancer Treatments in Universal Healthcare Systems: A Dutch Case Study.

IF 1.8 3区 哲学 Q2 ETHICS Journal of Bioethical Inquiry Pub Date : 2024-09-26 DOI:10.1007/s11673-024-10342-2
C H C Bomhof, Eline M Bunnik
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Abstract

With the increasing prices of newly approved anti-cancer treatments contributing to rising healthcare costs, healthcare systems are facing complex economic and ethical dilemmas. Especially in countries with universal access and mandatory health insurance, including many European countries, the organizing of funding or reimbursement of expensive new treatments can be challenging. When expensive anti-cancer treatments are deemed safe and effective, but are not (yet) reimbursed, ethical dilemmas arise. In countries with universal healthcare systems, such as the Netherlands, this gives rise to a rather new ethical dilemma: should patients be allowed to pay out of pocket, using private funds, for medical treatments? On the one hand, to allow patients to pay for treatments out of pocket would be in line with the medical-ethical principles of beneficence and autonomy. On the other hand, allowing patients to pay out of pocket for anti-cancer treatments may lead to unequal access to medical treatments and could be considered unfair to patients who are less well-off. Thus, it could undermine the values of equality and solidarity, on which the Dutch healthcare system is built. Furthermore, out-of-pocket payments could potentially lead to financial hardship and distress for patients, which would conflict with the principle of non-maleficence. Does this mean that patients can rightfully be denied access to approved but not (yet) reimbursed anti-cancer treatments? In this article, we will use the Dutch healthcare system, which is based on equal access and solidarity, as a case study to draw attention to this-currently relatively unknown and unresolved-dilemma and to clarify the values at stake. This article contributes to current discussions about the societal problem of rising healthcare costs by informing policymakers, healthcare professionals, and ethicists about the ethical dilemma of out-of-pocket payments in universal healthcare systems, and aims to support health authorities, policymakers and health professionals in developing policy for whether to allow out-of-pocket payment-based access to newly approved but (too) expensive anti-cancer treatments.

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是否应允许患者自费?在全民医疗体系中获得昂贵抗癌治疗的伦理困境:荷兰案例研究。
随着新批准的抗癌疗法的价格不断上涨,医疗成本也随之上升,医疗系统正面临着复杂的经济和伦理困境。特别是在包括许多欧洲国家在内的实行全民医保和强制医保的国家,组织资助或报销昂贵的新疗法可能是一项挑战。当昂贵的抗癌治疗被认为是安全有效的,但(尚未)获得报销时,就会出现伦理困境。在荷兰等实行全民医疗保健制度的国家,这就产生了一个相当新的伦理难题:是否应允许病人使用私人资金自掏腰包进行治疗?一方面,允许病人自掏腰包进行治疗符合医学伦理中的 "受益 "和 "自主 "原则。另一方面,允许病人自付抗癌治疗费用可能会导致获得医疗服务的机会不平等,可能会被认为对经济条件较差的病人不公平。因此,这可能会破坏平等和团结的价值观,而这正是荷兰医疗体系的基础。此外,自付费用有可能导致患者陷入经济困境和痛苦,这与 "非善意 "原则相冲突。这是否意味着患者可以被正当地拒绝接受已获批准但(尚未)报销的抗癌治疗?在本文中,我们将以建立在平等就医和团结互助基础上的荷兰医疗保健体系为案例,提请人们关注这一目前相对未知和悬而未决的难题,并厘清其中蕴含的价值。本文通过向政策制定者、医疗保健专业人士和伦理学家介绍全民医疗保健体系中自费支付的伦理困境,为当前有关医疗保健成本上升这一社会问题的讨论做出贡献,并旨在支持卫生当局、政策制定者和医疗保健专业人士制定政策,以决定是否允许自费支付新批准但(过于)昂贵的抗癌治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Bioethical Inquiry
Journal of Bioethical Inquiry 医学-医学:伦理
CiteScore
5.20
自引率
8.30%
发文量
67
审稿时长
>12 weeks
期刊介绍: The JBI welcomes both reports of empirical research and articles that increase theoretical understanding of medicine and health care, the health professions and the biological sciences. The JBI is also open to critical reflections on medicine and conventional bioethics, the nature of health, illness and disability, the sources of ethics, the nature of ethical communities, and possible implications of new developments in science and technology for social and cultural life and human identity. We welcome contributions from perspectives that are less commonly published in existing journals in the field and reports of empirical research studies using both qualitative and quantitative methodologies. The JBI accepts contributions from authors working in or across disciplines including – but not limited to – the following: -philosophy- bioethics- economics- social theory- law- public health and epidemiology- anthropology- psychology- feminism- gay and lesbian studies- linguistics and discourse analysis- cultural studies- disability studies- history- literature and literary studies- environmental sciences- theology and religious studies
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