Human resource mechanisms in healthcare

This is an Open Access article: This article has been cited by other articles in PMC. Abstract In the last few years, increasing attention has been paid to the development of health policies.

Human resource mechanisms in healthcare

This article has been cited by other articles in PMC. Abstract For decades, the problem of how to allocate healthcare resources in a just and equitable fashion has been the subject of concerted discussion and analysis, yet the issue has stubbornly resisted resolution.

This article suggests that a major reason for this is that the discussion has focused exclusively on the nature and status of the material resources, and that the nature and role of the medical profession have been entirely ignored. Because physicians are gatekeepers to healthcare resources, their role in allocation is central from a process perspective.

This article identifies 3 distinct interpretations of the nature of medicine, shows how each mandates a different method of allocation, and argues that unless an appropriate model of medicine is developed that acknowledges the valid points contained in each of the 3 approaches, the allocation problem will remain unsolvable.

Introduction When resources are limited and demand exceeds supply, allocation becomes a problem. How that problem is solved depends largely on the nature of the resources themselves.

When the resources are construed as social goods, allocation may proceed either in terms of competition between individuals on the basis of the relative strengths of their competing rights, or on an aggregate basis by evaluating which distribution would be likely to produce the greatest amount of good for the greatest number of people.

When the resources are construed as commodities, the allocation problem assumes a different orientation. Notions of competing rights or of maximizing the aggregate good drop out of the picture and economic considerations take their place.

Human resource mechanisms in healthcare

These considerations apply to healthcare as much as they do to anything else. Healthcare resources, whether understood in material or in human terms, are limited, nor is this a function of how healthcare is delivered. The fact of limitation is inherent in the human condition.

Whether healthcare is delivered in a private or in a public setting — or even in a mixture of both — the number of people who can deliver the care is always limited because not everyone can be a healthcare professional and even healthcare professionals may fall ill and require care, thus making them unavailable as healthcare providers.

The amount of resources will always be limited because there is a limit to the number of facilities that can be constructed, the number of instruments that can be manufactured, or the number of organs, amount of blood, etc that will be available.

The demand for healthcare resources, therefore, will always and necessarily exceed supply. That means that limitation is not an artifact, and that there will always be an allocation problem.

How is it to be resolved? Traditionally, the issue has been dealt with by a complex mix of approaches that try to balance competing rights and duties with cost and outcome measures. However, if the current literature and current policy discussions are anything to go on, these attempts cannot really be considered successful.

The issue requires an overall solution that can be consistently applied across the whole field of healthcare, not something that works in isolated instances and that can be applied in only selected areas and in a piecemeal fashion.

In this article, I want to explore why the healthcare resource allocation problem has so stubbornly resisted solution, and sketch the beginnings of a solution. I am going to suggest that the usual approaches to the allocation problem are based on a selective approach to what actually goes on in healthcare resource allocation, and that the reason the problem has proved so intractable is precisely because it has been approached in this limited fashion.

Specifically, I am going to suggest that concentrating mainly on the material resources — which is the traditional way of approaching the issue — is part of the problem.

It ignores the fact that it is the healthcare professionals — which is to say, the human resources — who turn what otherwise are merely material things into healthcare resources. Moreover, from a process perspective, it is the healthcare professionals who function as gatekeepers to the material resources that are in short supply.

Human resource mechanisms in healthcare

They are, so to speak, the choke point in the access and distribution systems. That is why how they function determines what shape the resource allocation issue will ultimately take. This is not to say that the status of the material healthcare resources — whether they are treated as social goods or as commodities — is unimportant.

Clearly, that would be a mistake. However, it is to say that this is only part of the picture and, from a process perspective, a secondary part at that.

Until the role of the human resources — of the healthcare professionals — has been clarified, the whole debate over the status of the material resources contributes very little to a solution, and the question of what allocation mechanism is appropriate can receive only a partial answer.

The discussion that follows will attempt to show how this is the case. Therefore, it will not deal with healthcare resources as understood in the material sense, but only with the human side of the equation, ie, it will deal only with the nature, role, and ethical status of the healthcare professions and with the implications that this has for resource allocation.

Even here the discussion will be limited. It will consider only a specific subgroup of healthcare professionals, namely, physicians. It will identify and briefly sketch several distinct conceptualizations of the profession of medicine, trace their ethical implications, and show how they legitimate different approaches to resource allocation because of the distinctive gatekeeper roles that physicians play within these different conceptualizations.

Subsequent discussions will then deal with the ethical status of material healthcare resources, integrate this into a process model of healthcare professionals as gatekeepers, and develop a general framework for healthcare resource allocation that takes these various factors into account.

Healthcare Resources in Human Terms The Hippocratic Model Medicine — and, to reiterate, the present discussion is confined to human healthcare resources as focused in the medical profession — has traditionally presented its nature and purpose as being embodied in the spirit of the Hippocratic oath.

It establishes a fiduciary relationship between the physician and the patient. The point is sufficiently important to deserve restating.Global Strategy on Human Resources for Health: Workforce – Summary 1 Policy and actions at “country” or “national” level should be understood as relevant in each country in accordance with subnational and national responsibilities.

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