MRG Principles and Policy Statements

MRG Policy Statement on Health Resource Allocation.

We believe our position should be based on the following four principles which we found very useful as a conceptual framework. These principles are presented in their order of importance:

  1. Equity - Everyone should have equal opportunities to make use of available health care resources, and equal opportunity to live in an environment conducive to good health.

  2. Societal Perspective - Taking a societal perspective has two major implications. First, that the roots of ill health can be found in political, economic, and social policies and situations. Therefore, health may be improved more by spending money to correct the roots of ill health (and thus spent outside of the health care system) than by spending within the system. Second, spending on health care should be examined within the context of total societal resource allocation. As we have implied in our introduction, it could then be argued that, given the way society currently allocates its resources, there is no crisis of health care costs at all. In other words (to use an extreme example) if money to be spent on nuclear submarines were diverted to health care, the cost crunch would be alleviated or eliminated.

    Seen in this context, spending on even marginally effective therapies could be justified. That is, if an intervention does prolong or improve the quality of life, it is a more worthwhile allocation of resources than, for example, enhancing corporate profits.

  3. Effectiveness - Health care diagnostic and therapeutic technologies should be supported only if they have been shown to improve outcome (i.e. the length and/or quality of life). The burden of proof to establish this benefit should be on those lobbying for the acquisition or dissemination of expensive technologies.

    Consideration of quality of life outcomes implies a "humanist" perspective that may outweigh considerations of "cost-effectiveness" (when effectiveness is narrowly defined). An example would be allocation of health care resources to the elderly.

  4. Efficiency - The efficient distribution of resources (maximizing cost-effectiveness) within the health care system should be one goal of the system. This was seen as very definitely the bottom of the list in terms of the four principles.

In the final part of the discussion, we provide examples of how these principles could be brought to bear on the current issues regarding health care delivery in Ontario.

Equity

We would continue to oppose any proposal, like user fees, which would compromise equity. We would support proposals, like selective allocation of resources to the economically disadvantaged, or to the socially or physically disadvantaged, that would improve equity.

Societal Perspective

In general, we would lobby for allocation of resources in ways that would improve health outcomes, and against allocation of resources in ways that would have adverse health consequences. This would be true both in and outside of the health care delivery system. There are a number of specific areas in which the MRG could lobby on the basis of the health consequences of societal decisions regarding resource allocation. Examples include the following:

  1. Support for the tobacco farmers: we might support allocation of funds for switching over from growing tobacco to other crops.
  2. Social programs which would improve health: we might support programs which would deal more effectively with homelessness, and with domestic violence and its consequences. We could suggest that the health costs of unemployment be factored in when the decisions concerning employment subsidies, job creation schemes, and the like are considered.
  3. Road traffic accidents: me might support changes in the transport policy that would decrease the number of civilian casualties in highway wars.
  4. Alcohol: we might support policies that would decrease alcohol consumption, and the consequent deleterious health effects.
  5. Occupational health: we might emphasize stands we have already taken in support of a safer work place.
  6. Nutrition: we might support policies that would encourage the production and consumption of healthier foods.

Conceivably, we might prepare a yearly commentary on the provincial budget from the point of view of its impact on the health of the people of Ontario, in terms of issues such as those raised above.

Effectiveness

We could speak against allocation of resources to any new technology in which evidence of improved outcome was not available. This would clearly mean knowledge of the evidence regarding the issue about which we spoke.

Efficiency

While we would certainly support an efficient allocation of resources within the health care system, we recognize that there is currently a danger in so doing. The reason is that, because of the atmosphere of general assault on health care spending, money saved on health care spending is unlikely to be spent on other more cost-effective (in terms of improving health) social programs. Nevertheless, there will be instances in which the MRG will want to speak in favour of efficient allocation of health care resources. One might be expenditure on the development of new pharmaceutical agents which achieve little incremental advantage over existing agents (so-call "me too" drugs). Another might be expenditures on sophisticated imaging technologies in which effect on health outcomes is likely to be minimal. Whenever such statements are made, we feel that it is crucial to emphasize the areas to which the money saved should be allocated. Such areas might include:

  1. home care for the elderly (despite its cost-ineffectiveness)
  2. palliative care
  3. shelter for battered wives
  4. social, environmental, and nutritional intervention in pre-natal care
  5. occupational health
  6. family planning clinics
  7. mammographic screening in 50 to 60 year old women
  8. dental care for the chronically psychiatrically ill
  9. chronic care facilities for the handicapped

We believe issues of resource allocation will determine the future of health care in Ontario. The MRG must take part in what is certain to be a heated debate. Clearly, we hope the membership will in general endorse the principles we have outlined. Most certainly, we hope these principles will be given thought and consideration, and useful alternatives or modifications will be raised.


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