AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. April 2011, Volume 13, Number 4: 207-267.

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April 2011 Contents

The "R" Word—Ethical Allocation of Medicine's Services

Ethics Poll

The cost effectiveness of a medical intervention is often expressed in the number of "quality-adjusted life years" (QALYs) the intervention is expected to add to an individual's life. Which of the following best expresses what you know about QALYs?
The National Institute for Health and Clinical Excellence in the U.K. has used a cost per QALY of 30,000 pounds sterling (approximately $48,000) as the benchmark for its publically funded health service. A treatment that costs less than $48,000 per quality-adjusted life year gained will generally be approved, and an intervention costing more will be refused. By this criterion, even treatments with positive clinical outcomes will be unavailable from the National Health Service if their cost per QALY exceeds the threshold. If the U.S. were to apply the cost-per-QALY concept to its publically funded health programs, Medicare and Medicaid, what do you think the benchmark of cost per QALY should be?
Many people have pointed out that rationing of scarce medical resources has always been with us. People have access to medical services they can afford or their insurers (including the U.S. government) have agreed to cover. What do you think is the best way for allocation of scarce medical resources, i.e., rationing decisions, to be made?

From the Editor

Confronting the “R” Word
Melanie Mund
Full Text | PDF
Virtual Mentor. 2011; 13:209-210.

Educating for Professionalism

Clinical Cases

Cost Effectiveness in Clinical Screening
Commentary by Robert J. Karp and Yuriy Shepelyak
Full Text | PDF
Virtual Mentor. 2011; 13:211-216.

Patient Requests for Nonindicated Care
Commentary by Zachary Ginsberg and Erica Kreismann
Full Text | PDF
Virtual Mentor. 2011; 13:217-219.

Rationing Treatments Based on Their Cost per QALY
Commentary by David A. Wong
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Virtual Mentor. 2011; 13:220-223.

Medical Education

Teaching Resource Allocation—And Why It Matters
Meina Lee and Elizabeth Geelhoed
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Virtual Mentor. 2011; 13:224-227.

The Code Says

The AMA Code of Medical Ethics’ Opinion on on Allocating Medical Resources
Full Text | PDF
Virtual Mentor. 2011; 13:228-229.

Journal Discussion

Identifying Bedside Rationing
Taeho (Greg) Rhee
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Virtual Mentor. 2011; 13:230-232.

Clinical Pearl

Diagnosing Acute Low Back Pain
Robin Polansky
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Virtual Mentor. 2011; 13:233-236.

Law, Policy, and Society

Health Law

ERISA’s Effect on Claims of Injury due to Denial of Coverage
Ilene C. Albala
Full Text | PDF
Virtual Mentor. 2011; 13:237-240.

Policy Forum

Oregon’s Experiment with Prioritizing Public Health Care Services
Philip A. Perry and Timothy Hotze
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Virtual Mentor. 2011; 13:241-247.

How Comparative Effectiveness Research Feeds into Cost-Benefit Analyses
Kevin D. Frick
Full Text | PDF
Virtual Mentor. 2011; 13:248-250.

Medicine and Society

What Is a Life Worth?
Leonard M. Fleck
Full Text | PDF
Virtual Mentor. 2011; 13:251-255.

History, Art, and Narrative

Medical Narrative

The Other Limited Resource—Time with Patients
Douglas Jay Mund
Full Text | PDF
Virtual Mentor. 2011; 13:256-257.

Resources

Suggested Readings and Resources
PDF
Virtual Mentor. 2011; 13:258-265.

About the Contributors
Full Text | PDF
Virtual Mentor. 2011; 13:266-267.