Thesis (MBA)--Stellenbosch University, 2008. / ENGLISH ABSTRACT: The cost of medical care, in particular the cost of cancer care, has seen significant increases
globally in the last few years. These cost increases in part are a result of tremendous
advancements in new health technologies to diagnose, treat and care for cancer sufferers. The
development of these highly specialised treatment modalities is not expected to slow down in
the next few years, as potentially new treatments are already in the pipeline.
On the other hand, cancer is becoming more prevalent. affecting more people worldwide. The
condition remains life threatening, causing patients to become dependent and desperately
hopeful of their requested treatments. Managed care, which includes the processes of rationing,
has been implemented by medical aid schemes in the private health care industry in an effort to
curtail the escalating costs of health care. Currently medical aids in the country are under
immense pressure to comply with financially demanding legislation as well as to increase their
membership risk by keeping contributions low and subsequently improve access to private
health care in the country.
Notwithstanding the fact that rationing might be justified from an economic perspective, the
implications of transposing free market principles into an almost sacred health care environment
challenges current morals and ethics in this arena. The price consciousness in cancer care is
almost creating a scenario where clinical reasons are becoming subservient to fiscal reasons or,
put differently, it is placing a price tag on human lives.
In its true glory, the rationale of rationing is to challenge the individual patient needs against that
of the bigger medical aid society. The distributive justice principles of rationing are creating
immense conflict between the virtue-based, principle-based and contemporary ethics, which are
currently governing medical practice in the country. As a result rationing creates serious vexing
funding decisions with long-ranging effects.
Its against this background that the study further consider the implications of managed care and
rationing as it creates serious questions about the fairness, decision-making power and
authority of managed care organizations. The implication of this is that the treating physician
seems to have lost all autonomy and control in trying to treat and care for his cancer patient.
Hence the perception that managed care does not act in the best interest of the vulnerable and
desperate cancer suffering patient.
As a result of th is view of managed care it becomes important to ensure the fairness and or
legitimacy of managed care and rationing decisions. Therefore, the final section of the study
considers the fair and just rationing of medical care as well as setting limits that are morally and
ethically acceptable, in a cancer related setting. The studies of Daniels and Sabin are utilized
extensively in particular the suggested criteria required by managed care organisations to
ensure their rationing decisions are fair and legitimate. The implications of this and the
assurances to cancer sufferers in a medical scheme is that the decisions to fund new health
technologies are based on a process that is transparent and collaborative and that cost
consideration of treatment has merit if it is made within the confines of this process. / AFRIKAANSE OPSOMMING: Die koste van mediese sorg, en spesifiek die koste van kankersorg, het in die afgelope paar
jaar wereldwyd aansienlik toegeneem. Hierdie toename in koste is gedeeltelik die resultaat van
geweldige vooruitgang in nuwe gesondheidstegnologiee om kankerlyers te diagnoseer, te
behandel en vir hulle te sorgo Daar word nie verwag dat die ontwikkeling van hierdie hoogs
gespesialiseerde behandelingsmodaliteite oor die volgende paar jaar sal afneem nie, aangesien
nuwe behandelings steeds geregistreer word.
Aan die ander kant is die voorkomssyfer van kanker besig om toe te neem, en be"invloed dit
mense oor die hele wereld. Die toestand is steeds lewensbedreigend, en veroorsaak dat
pasiente afhanklik van en desperaat vol hoop is vir die nodige behandeling. Bestuurde sorg, wat
die proses van rantsoenering insluit, is deur mediesefondsskemas in die privaat
gesondheidsorgbedryf ge"lmplementeer in 'n poging om die stygende koste van mediese sorg te
verminder. Mediese fondse in die land is tans onder geweldige druk om aan finansieel
veeleisende wetgewing te voldoen en om hulle lidmaatskaprisiko te verhoog deur bydraes laag
te hou en gevolglik toegang tot privaat gesondheidsorg in die land te verbeter.
Ondanks die feit dat rantsoenering moontlik vanuit 'n ekonomiese perspektief geregverdig kan
word, daag die implikasies van die omsetting van vryemarkbeginsels in 'n amper heilige
gesondheidsorgomgewing huidige morele waardes en etiek in hierdie veld uit. Die
prysbewustheid in kankersorg skep amper 'n scenario waar kliniese redes ondergeskik aan
fiskale redes gestel word of, om dit anders te stel, dit plaas 'n prys op mense se lewens.
In sy volle glorie is die rasionaal van rantsoenering om die individuele pasient se behoeftes
teenoor die van die groter mediesefondssamelewing te stel. Die beginsels van verdelende
regverdigheid van rantsoenering skep enorme konflik tussen die deug..gebaseerde, beginselgebaseerde
en kontemporere etiek wat tans die mediese praktyk in die land beheer. Gevolglik
skep rantsoenering ernstige, moeilike befondsingsbesluite met effekte oor die lang termyn.
Oit is teen hierdie agtergrond dat die studie die verdere implikasies van bestuurde sorg en
rantsoenering moet oorweeg, aangesien dit ernstige vrae rondom die billikheid , besluitneming
en outoriteit van bestuurde sorg maatskappye lig. By implikasie beteken dit dat die geneesheer
wat die pasient behandel, feitlik aile beheer verloor het om die pasient vir aile praktiese
doeleindes optimaal te behandel. Oaarom die persepsie dat bestuurde sorg nie in die beste
belang van die kwesbare en desperaat kanker pasiente is nie.
As gevolg van die persepsie van bestuurde sorg, raak dit meer belangrik om die bilikheid en
regverdigheid van gesondheid sorg besluite te verseker. Met dit in ag genome, oorweeg die
finale deel van die studie die bilikheid en regverdigheid van mediese rantsoenering so-ook die
set van perke wat eties en moreel aanvaarbaar is, in 'n kanker verwante agtergrond. Die werke
van Daniels en Sabin word in aansienlike detail hersien in besonder hul voorgestelde kriteria
wat vereis word deur bestuurde sorg organisasies om te verseker hul besluite ten opsigte van
rantsoenering is redelik en regverdig. Die implikasies hiervan en die versekering tot kanker Iyers
in 'n mediese skema is dat die besluite om nuwe gesondheidstegnologiee te befonds, is
gebasseer op In deursigtige en samehorende proses en dat aile koste oorwegings vir
behandeling meriete het, indien dit is gemaak is binne die raamwerk van hierdie proses.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/17470 |
| Date | 12 1900 |
| Creators | Allies, Shaun Brandon |
| Contributors | Malan, Daniel, Stellenbosch University. Faculty of Economic and Management Sciences. Graduate School of Business. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | English |
| Type | Thesis |
| Rights | Stellenbosch University |
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