A discussion on the ethical complexities of micro-level decision making in the South African private health insurance industry.

Abstract

Health and, by extension, healthcare is accepted to be a valuable and important social good that is both a good in and of itself, as well as necessary to achieve life’s goals. Its fair distribution is therefore properly the subject of ethical concern and in the era of modern medicine where costs and potentially limitless treatments exceed available resources, rationing healthcare has become an unavoidable necessity. Since such rationing implies that not everyone’s needs or preferences can be met, a fair and just way of rationing healthcare is a widely debated and controversial topic that, to date, remains unresolved. Where third-party private funding organisations are tasked with these rationing responsibilities, the ethical complexities are compounded by perceived conflicts between the ethical frameworks that govern corporate organisations versus those that govern healthcare. Given the apparent inability of normative theories to resolve the problem of how to ration healthcare fairly, there has been a shift in thinking to considerations of procedural justice and a dominant model, Accountability for Reasonableness (AFR), has emerged as the favoured procedure for healthcare decision-making. The report shows why health is an important social value and examines the key models and principles that dominate the rationing debate as well as why the conflict between healthcare ethics and organisational ethics create additional complexities that must be considered when making these funding decisions. Furthermore it explores the rationales for resorting to procedural accounts with specific emphasis on the parameters and validity of AFR. The report concludes that even though the AFR framework may be a legitimate and just process that can effectively frame decision-making and provide a platform to drive transparency and consistency, like most procedural accounts, it does not guarantee that the outcomes it produces are necessarily fair or just. Therefore a straightforward application of AFR cannot resolve the healthcare rationing debate which should, given its ethical complexity, continue to appeal to the important ethical principles that currently govern the field.