Zdravotnické technologiev empirickém šetřeníHodnocení dostupnosti a dalších etických aspektůu vybraných technologií v českém prostředí

Healthcare Technologies underEmpirical Scrutiny: Assessment of Availability and other Ethical Aspects in Selected Technologiesin Czech Circumstances

The paper deals with the problem of „rationing“ expensive care which is connected with thenecessity of selecting patients because it is not possible to provide that care to all of the patientswho could be clinically benefited by it, be it for insufficient capacity of the facility, financial orother reasons. In a series of interviews with the heads of selected departments providingsuper-specialized healthcare there has been discussed the current situation from the point ofview of changes connected with the transformation of healthcare with special emphasis on theimpact of changes in financing since 1997. Further, there has been discussed the problem ofselecting patients, the transparency of allotting care and the interference of non-clinical aspectsinto the process of that allotting. The providing of healthcare proceeds on the basis of applyingexplicit as well as implicit criteria.Among the explicit ones it is first of all clinical characteristicsthat assert themselves. Except for minor exceptions the situation at the time of the survey (year2000) was assessed positively from the point of view of rationing, without any marked signs ofdisproportions between clinical need and available capacities. Such evaluations are probablyinfluenced to a large degree by continual comparisons of current possibilities with the situationpreceding the year 1989, however, it cannot be ruled out that the need of super-specializedhealthcare is very under-dimensioned due to bad coordination of services at lower levels of thehealthcare system and the „holding up“ of patients in primary and out-patient specialized care.

Key words:
modern technologies - costs - rationing - explicit and implicit rationing.