Ethical Principles in Resources Allocation

Introduction

Ethics attempts to deal with the broad philosophical questions of what we ought to do. It can be a potentially controversial and even divisive area of debate. Ethics is about values and principles, and about the development of rules and guiding principles (criteria) for decision-making. A Set of ethical guidelines can be a valuable decision-making tool. (Chu, 2009).
Need to distinguish between ethics and morals–“ethics”-derived from Greek–“morals”-derived from Latin. Both are concerned with the values and beliefs individuals / groups hold in relation to human behavior, often used interchangeably. Morals tend to refer to standards held by individuals or groups whilst ethics refers to the science or study of morals. Ethic refers to the collective belief-and-value system of any moral community, social or professional group. Ethics serve to identify good, desirable, or acceptable conduct and provide reasons for those conclusions. Ethics relates to practical knowledge and skills in the application of principles on which moral rules and values are based decision-making skills involved in applying moral principles to practical situations decision procedures specific or appropriate to various contexts and situations. (Chu, 2009).
Ethics is moral rules or principles that influence person’s behavior to decide what is right and wrong. (Oxford, 2007). Ethical principles in resources allocation is considering the ethics principles in decision making in resources allocation including distribution of resources among competing programs or people (Brook, 2006). In addition, there are five criteria should manager use for resource allocation decision-making, to resonate across the various disciplines, they are – mission, quality, efficiency, need, and process Singer (1994).
This paper discus the ethical issues in the resources allocation decision making process and it is implementing in the public health decision –making in Health Department Republic of Indonesia.

Ethical principles Public Health decision-making and resource allocation
While a nation’s resource is limited, there are competing demands from different sectors for the money, how should a nation spend the money? How much should a nation spend on health? As health costs increases rapidly, uncontrolled, it will be throwing into a bottomless hole, so how do we control the budget? Those are some issues should be considering in health decision making.
Chu (2009) stated that there are 5 guiding principles (Ethical decisions) for resource allocation in public health.
Health spending, who should benefit from the decision-making.
Who should make decision (process Decision-making )
Individual responsibility or collective responsibility.
Direction of technological development?
Health research funding?
In addition, Brock (2006) stated that ethical principles in the resources allocation generally must satisfy two criteria: cost–effectiveness and equity. Sometimes efficiency and equity coincide; but in many cases, there are moral reasons for an allocation that is not cost–effective. Cost effective analysis (CEA) can provide a framework for decision-makers at all levels for systematically evaluating the implications of resource allocation.
Moreover, Singer (1994) stated that resource allocation is an ethical issue because it most fundamentally involves questions of justice. The goal of resource allocation is to make fair decisions. There is no consensus on what is "fair" means, and this is where the dilemma. For instance, utilitarianism focuses on the maximization of benefit, while egalitarianism focuses on equality. A legal scholar would talk about procedures for decision-making. An economist would focus on economic theories that have a utilitarian basis. A political scientist would focus on democratic theory and participation in decision- making. A management scholar would focus on the mission, program priorities, and quality of care. A health scientist would focus on evidence-based medicine. In addition, Singer (1994) stated that there are five criteria should manager use for resource allocation decision-making, to resonate across the various disciplines, they are – mission, quality, efficiency, need, and process.
Case study resources allocation in Indonesia
In this case study, I will explain some principles which is equity and process decision making and technological driven.

Principle 1: Health spending, who should benefit from the decision-making.
In Indonesia, the government spends money more on individual health rather then on community health. Around 43% of government budget spend on individual health, and 30.9% spend on community health. (World Bank, 2008). In Nusa Tenggara Timur (NTT) Province, around 76% of budged in the health sector, spend on individual health, and 24% spend on community health. (MOH, 2005). Ccommunity health program focus on the provision of public health canters and their networks, including community health canter (Puskesmas), mobile public health canters and village midwives. The community health program also includes immunization, environmental health programs, and other traditional public health activities. And the individual health program is focus on providing hospital care. The question is, should the government spend more budged on the individual health (hospital) rather than on community health? Some activities in the community health are focus on social determinants of health and individual focus on curative?
In this case, my opinion is the government should spend money more on the public health or community health than on individual health. The reason is around 70-80 percent people are need to maintain and increase their health through promotive and preventive program, and around 20% of people in Indonesia is need health care in hospital. Other reason is community health is focus on social determinants of health which can conduct by public health centre (puskesmas), but individual health is focus on curative program.

Principe 2: Who should make decisions?
It is related to the decision making process. The final decision maker in the health sector in Indonesia is Ministry of Health in the national levels and head of provincial health office in provincial levels. In the public health resources allocation, planning and budgeting in the health department in Indonesia is a political process, lobby, not just a technocratic or scientific based. The consequences are some programs known to be less important and cost effective. In the some program in the health department, decision-making just conduct by the leader in the department without involve the other parties in the decision making process.
In my opinion, decision making process should be involved other parties or other department. The reason is the manager may have limited information related to the program. Involving other sectors in the decision-making process can improve the quality of output in the decision-making. More over, decision-making should be scientific based not based on the political process or lobby.

Principle 3: Direction of technological development
In the global context, invest in the technological development is increase in the health sector , for example development technology for reproductive, body image and commercial trends, reproductive functions and aging, cloning etc. (Chu, 2009). In Indonesia, the government spent more budged on the medical technology particularly in hospital. It is important to help the doctor or para medic to make a good decision or an appropriate diagnose to the patient. In this case, I disagree that government spent budget more on in the technological development. The reason is technology approach some time can make people feel dependent to the technology. People don’t think to reduce the determinants of the disease. Some times, technology is harm for the environment because of the waste when the technology are producing in the industry or when the technology can not use and become waste.
Conclusion
Ethical principles in resources allocation is considering the ethics principles in decision making in resources allocation including distribution of resources among competing programs or people. The ethical principles in resources allocation in decision making are equity, effective, fair, etc. There are five criteria should manager use for resource allocation decision-making, to resonate across the various disciplines, they are – mission, quality, efficiency, need, and process.

References

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Singer, A. Peter., Mapa, Joseph. (1994). Ethics of resource allocation: dimensions for health care executives. Retrieve May, 20, 2009, from www.longwoods.com/product.php?productid=16387

World Bank Indonesia. (2008). Investing in Indonesia’s health, challenges and opportunities for future public spending. Health public spanding review, 2008. retrieved 21 May, 2009 from http://siteresources.worldbank.org/INTINDONESIA/Resources/Publication/.pdf