How can we decide a fair allocation of healthcare resources during a pandemic?

Abstract

Whenever the government makes medical resource allocation choices, there will be opportunity costs associated with those choices: some patients will have treatment and live longer, while a different group of patients will die prematurely. Because of this, we have to make sure that the benefits we get from investing in treatment A are large enough to justify the benefits forgone from not investing in the next best alternative, treatment B. There has been an increase in spending and reallocation of resources during the COVID-19 pandemic that may have been warranted given the urgency of the situation. However, these actions do not bypass the opportunity cost principle although they can appear to in the short term, since spending increases cannot continue indefinitely and there are patient groups who lose out when resources are redirected to pandemic services. Therefore, policy-makers must consider who bears the cost of the displaced healthcare resources. Failure to do so runs a risk of reducing overall population health while disproportionally worsening health in socially disadvantaged groups. We give the example of ethnic minorities in England who already had the worst health and, due to structural injustices, were hardest hit by the pandemic and may stand to lose the most when services are reallocated to meet the resource demands of the crisis. How can we prevent this form of health inequity? Our proposal is forward-looking: we suggest that the government should invest our resources wisely while taking issues of equity into account–that is, introduce cost–equity analysis.

Forgone Health Care for Non–COVID-19–Related Needs Among Medicare Beneficiaries During the COVID-19 Pandemic, Summer 2020–Winter 2021

“…The problem of forgone health care encompasses multiple factors such as government and provider policy, perceived risk, and financial costs (8)(9)(10). The COVID-19 pandemic has directly affected all 3 factors.…”

Clinical Ethics Consultation During the First COVID-19 Pandemic Surge at an Academic Medical Center: A Mixed Methods Analysis

“…While these numbers are staggering, they do not capture the toll this pandemic has had, and continues to have, on every aspect of society, especially healthcare (Baines et al, 2020 ). Many ethical issues have emerged in healthcare settings across the world ranging from policies for crisis standards of care to dilemmas about specific patient cases (Baines et al, 2020 ; Fins & Prager, 2020 ; Fischkoff et al, 2020 ; Roadevin & Hill, 2021 ; Schmidt, Roberts, & Eneanya, 2021 ).…”

The impact of COVID-19 on persons affected by leprosy and leprosy control in the North and Northeast of Brazil

“…28 During the pandemic, health staff were transferred to Covid-19 related health services. 29 This task-shifting process could be a significant factor contributing to the decreased number of contacts undergoing leprosy screening during the pandemic. Providing leprosy post-exposure prophylaxis (PEP) with a single dose of rifampicin (SDR) is not yet a standard component of leprosy control in Brazil.…”