Economically Unsustainable Drugs and Intergenerational Health Care Justice

"Introduction. The recent introduction of extremely effective drugs in treating diseases, but associated with exorbitant costs raised several issues in terms of distributive justice. However, in this debate justice is widely thought in intragenerational terms. The work will explore the concept of intergenerational health care justice, in particular the argument, often used to justify the introduction of this type of drugs, according to which the vast amount of money spent now will allow to have savings in the long run. The recent introduction of some drugs that are extremely effective in treating diseases but associated with exorbitant costs, raised several issues in terms of distributive justice. However, in this debate justice is widely thought in intragenerational terms. Methods: A review of key documents on intergenerational justice was conducted, followed by a nonsystematic review of peer-reviewed and gray literature. The existing material was analyzed and a draft manuscript was prepared and discussed. Some experts carried out the revision of the manuscript until consensus was reached. Results: The concept of intergenerational health care justice has never been well explored. From an intergenerational point of view, the argument – which is often supported by pharmaco-economic evaluations – according to which the vast amount of money spent now for this type of drugs will allow to have savings in the long run is not in itself coherent with the main theories of justice. Conclusions: Considerations that are extrinsic to the assumptions of the main theories of justice are needed in order to justify the argument above. "

Universalidade e democracia: esteios das ciências contra o charlatanismo

Um novo paradigma do conhecimento parece surgir da hecatombe virótica e política que atinge principalmente as Américas para talvez enterrar de vez ou, pelo menos, inativar temporariamente a virulência do anterior, que deu abrigo a teorias como a da Escolha Racional, que é o paradigma neoliberal. Contra ele, ressurge a tese dos sistemas universais de saúde enquanto estruturas de Estado, mantidas e controladas pelo próprio Estado Ampliado, no sentido gramsciano. O editorial do volume 11, ano 2021, segundo ano da pandemia de COVID-19 do século XXI, tem por objetivo apresentar de forma reflexiva dez artigos do número 1, com temas que abordam diretamente ou indiretamente a pandemia, seus desdobramentos, tomando como valores orientadores das práticas editoriais, de pesquisa e cuidado em saúde, a justiça e democracia, mais que conceitos, significantes para o pensamento e a ação. ABSTRACTA new paradigm of knowledge seems to emerge from the viral and political hecatomb that affects mainly the Americas to perhaps bury forever or at least temporarily inactivate the virulence of the previous one, which gave shelter to theories such as Rational Choice, which is the neoliberal paradigm. Against him, the thesis of universal health systems resurfaces as State structures, maintained and controlled by the Extended State itself, in the Gramscian sense. The editorial of the volume 11, 2021, second year of the COVID-19 pandemic, of the 21st century, aims to reflectively present ten articles published on number 1 with themes that directly or indirectly address the pandemic, its consequences, taking as guiding values of editorial practices, research and health care, justice and democracy, more than concepts, significant for thought and action.Keywords: COVID-19; Pandemic; Sciences; Universality; Democracy; Health. RESUMENUn nuevo paradigma de conocimiento parece emerger de la hecatombe viral y política que afecta principalmente a las Américas para quizás enterrar definitivamente o al menos inactivar temporalmente la virulencia del anterior, que dio cobijo a teorías como la Elección Racional, que es el paradigma neoliberal. Frente a él, la tesis de los sistemas de salud universales resurge como estructuras estatales, mantenidas y controladas por el propio Estado Extendido, en el sentido gramciano. El editorial del volumen 11, año 2021, segundo año de la pandemia COVID-19, del siglo XXI, tiene como objetivo presentar de manera reflexiva diez artículos del número 1, con temas que aborden directa o indirectamente la pandemia, sus consecuencias, tomando como rector valores de las prácticas editoriales, la investigación y la salud, la justicia y la democracia, más que conceptos, significativos para el pensamiento y la acción.Palabras clave: COVID-19; Pandemia; Ciencias; Universalidad; Democracia; Salud.

What matters in health (care) universes: delusions, dilutions, and ways towards universal health justice

The presumed global consensus on achieving Universal Health Coverage (UHC) masks crucial issues regarding the principles and politics of what constitutes “universality” and what matters, past and present, in the struggle for health (care) justice. This article focuses on three dimensions of the problematic: 1) we unpack the rhetoric of UHC in terms of each of its three components: universal, health, and coverage; 2) paying special attention to Latin America, we revisit the neoliberal coup d’état against past and contemporary struggles for health justice, and we consider how the current neoliberal phase of capitalism has sought to arrest these struggles, co-opt their language, and narrow their vision; and 3) we re-imagine the contemporary challenges/dilemmas concerning health justice, transcending the false technocratic consensus around UHC and re-infusing the profoundly political nature of this struggle. In sum, as with the universe writ large, a range of matters matter: socio-political contexts at national and international levels, agenda-setting power, the battle over language, real policy effects, conceptual narratives, and people’s struggles for justice.

Our Peers—Empowerment and Navigational Support (OP-ENS): Development of a Peer Health Navigator Intervention to Support Medicaid Beneficiaries With Physical Disabilities

People with disabilities (PWD) are a health disparities population who experience well-documented physical, structural, attitudinal, and financial barriers to health care. The disability rights community is deeply engaged in advocacy to promote health care justice for all PWD. As the community continues to work toward systems change, there is a critical need for community-directed interventions that ensure individuals with disabilities are able to access the health care services they need and are entitled to. Peer health navigator (PHN) programs have been shown to help people from diverse underserved communities break down barriers to health care. The PHN model has not been systematically adapted to meet the needs of PWD. In this article, we describe the collaborative process of developing Our Peers—Empowerment and Navigational Supports (OP-ENS), an evidence-informed PHN intervention for Medicaid beneficiaries with physical disabilities in Chicago, IL, USA. Our Peers—Empowerment and Navigational Supports is a 12-month community-based PHN intervention that pairs Medicaid beneficiaries with physical disabilities (peers) with disability PHNs who use a structured recursive process of barrier identification and asset mapping, goal setting, and action planning to help peers meet their health care needs. Our Peers—Empowerment and Navigational Supports was developed by a collaborative team that included disability rights leaders, representatives from a Medicaid managed care organization, and academic disability health care justice researchers. We highlight both the conceptual and empirical evidence that informed OP-ENS as well as the lessons learned that can assist future developers.

Health-Care Justice, Health Inequalities, and U.S. Health System Reform

Changes in health system financing and delivery have the potential to save thousands of lives and billions of dollars. The overarching value system embedded in these new models for payment is a rough utilitarianism with origins in economic analysis. These models use financial incentives to change the behavior of physicians, hospitals, and patients. In addition, many of these policy approaches are also based in other normative approaches to medical care with links to liberal economic theory. While these utilitarian-based innovations in insurance and payment policy have often proven to improve access and quality of care in the aggregate, they have frequently been shown to have less benefit or even cause harm to vulnerable populations. This chapter demonstrates how improvements in quality of care frequently have the unintended consequence of widening disparities, either because the populations who had the worst outcomes to start with are more difficult to reach with improved-care models, or because the mechanisms designed to increase access and quality actually destabilize institutions that have long served the poor. As health reforms are implemented, attention to their impact on poor patients and the institutions that serve them will be essential.

Three Approaches to Global Health Care Justice: Rejecting the Positive/Negative Rights Distinction

This chapter presents three cosmopolitan approaches to global health care justice: Thomas Pogge's negative duties based approach, Gillian Brock's minimal needs view, and Henry Shue's model of basic rights. While these approaches share a common focus on attempting to justify the existence of global duties to aid, held by the wealthy and owed to the global poor, each offers a distinct interpretation of why such duties exist and suggests a range of options for fulfilling them. Importantly, while the chapter argues that Shue's approach to global duties is the most effective of the three, it considers that they all offer important insight into the problem of global poverty and provide a variety of possible practical solutions to this problem.