College of Engineering, Architecture, and Technology

"Equity versus Efficiency: Navigating Ethical Dilemmas in the Contemporary Healthcare

Resource Allocation"

Ethics

Submitted by:

Hilarie D. Casimiro

Submitted to:

Jumel G. Estranero

Course/Year/Section:

ARC22
 I. Prelude

The modern approach to healthcare systems and equitable distribution of resources raises an
important moral quandary. With the recent challenges of the pandemic known as COVID-19 to
the healthcare industry and resources, the ethical issues surrounding access to healthcare have
become even more pronounced. It can be difficult to make judgments that strike a balance
between efficiency such as maximizing the benefits of limited resources and equity, ensuring that
every individual has fair access to healthcare. For instance, discussions on the equitable
distribution of scarce resources, such as hospital beds, ventilators, and vaccines during the
pandemic have heated up in response to the increase in demand for medical treatment. Managing
the distribution of limited resources, addressing the inequities made worse by the pandemic, and
giving priority to treatment for specific populations have all brought attention to the pressing
need for ethical frameworks that direct equal access to healthcare. This crisis emphasizes how
crucial it is to strike a balance between equity and efficiency. The ethical dilemmas surrounding
healthcare access in the present put society's fundamental principles of justice and fairness in
jeopardy. Questions concerning who receives care and who does not are raised by the way
medical resources are distributed, which frequently reveals differences based on ethnicity,
geography, and financial position. All people should have the chance to attain optimal health,
and ethical considerations include resolving inequality and striking a balance between individual
demands and the greater good.

II. Body

Ethical Issues in Access to Healthcare

Healthcare access is the ability to obtain healthcare services such as prevention, diagnosis,
treatment, and management of diseases, illnesses, disorders, and other health-impacting
conditions. However, many people do not have access to adequate healthcare (Health Care
Access - MU School of Medicine, n.d.). Whenever a patient undergoes treatment, there are
always medical ethical issues to negotiate. Issues with waiting lists, access to medical resources,
and decisions on the correct course of treatment all pose ethical dilemmas (Team, 2024). The
medical world is constantly evolving, and as medical technology changes, doctors are left with a
host of new ethical issues. In a recent Sermo survey asking physicians the top medical issues
they faced, the most common result was balancing patient care quality and efficiency. Ethical
dilemma responses included:
 ● 21.4% Balancing care quality and efficiency
● 17.3% Allocating limited medications or tools of support
● 17.3% Addressing end-of-life issues
● 15.3% Addressing access to care
● 15.3% Doctor and patient confidentiality
● 13.3% Allocating limited donor organ

Barriers to Access

One way to look at the problem of healthcare access is in terms of such factors as the following
constituting “barriers” to access:

● Not enough donor organs for transplant

● Not enough primary care physicians
● Not enough medical schools
● Urban blight and rural poverty limit desirability of those neighborhoods for medical
practices
● No convenient and affordable transportation for poor patients to get to remote medical
offices or hospitals
● Patients cannot get time off of work
● Patients cannot obtain affordable childcare
● Limited hours, long waiting times, and limited after-hours care
● Insurance is not available at affordable rates to certain populations
● Prohibitive copayment fees for certain services
● Drug prices are too high
● Patients already with high medical debts
● Low health literacy
● Low level of computer skill
● Low level of computer and Internet access
● Undocumented residents from foreign countries having disadvantaged legal status
● The native language of the patient is not available at local facilities
● The country lacks healthcare professionals and facilities
● Climate factors create disease factors that overwhelm limited healthcare resources in
tropical countries
● Superstitions, suspicions, and cultural factors create prejudices against using Western
medical techniques
● The overall poverty level of individuals, population segments, countries, and continents

The list of barriers shows that there are various reasons for limited access to healthcare. Some
healthcare resources are in scarce supply in particular regions or time periods: organs, primary
care physicians, and advanced technologies, for instance. Sometimes it is a distribution problem:
resources are available but in the wrong location, for example in large cities but not rural areas.
Many times it is an affordability issue: some people are poor and uninsured or underinsured.

Medical education, healthcare infrastructure, organ allocation and distribution systems, and the
level of medical technology may be low or poorly developed or administered in a particular
country or in certain areas of a country. Distribution problems may mean no nearby doctor to
treat an individual, or a region or country unable to provide access to large population segments.
In limiting healthcare access, poverty affects whole countries as well as individuals (Health Care
Access - MU School of Medicine, n.d.).

Social Justices and Balancing Equity and Efficiency

Efficiency refers to the allocation of limited economic resources to meet the healthcare needs of
a society. Equity is the ‘fair’ distribution of benefits across the population. Health systems are
concerned not only with maximizing health but also with the fair distribution of health. However,
there is no consensus on what is ‘fair’, the decision is a moral rather than objective one
(Concepts of Need and Social Justice | Health Knowledge, n.d.).

In the constant battle between equity and efficiency in terms of healthcare resources and
allocation systems, ethical and social justice such as the following are the approaches to this
matter.

● Utilitarianism: strives to achieve ‘the greatest happiness for the greatest number’.
Benefits must be redistributed from the rich to the poor until there is an equal allocation
of benefits to all members of society. Utilitarianism is based on the idea that all people
have the same wants and capacity to enjoy benefits. An additional benefit given to a poor
person will provide more happiness than if the same additional benefit was given to a rich
person. Therefore, in order to maximize happiness in society, benefits must be
redistributed (Wonderling et al, 2005).

● Egalitarian: Everyone should have an equal opportunity to obtain benefits. No person

should be worse off than others except as a consequence of free and informed choices
(Concepts of Need and Social Justice | Health Knowledge, n.d.).

● Libertarian: Individuals have rights that the state must not violate. Above all individuals
have a right to freedom, the state should not interfere (Concepts of Need and Social
Justice | Health Knowledge, n.d.).

● Rawlsianism: Because there is a trade-off between efficiency and equity an unequal

distribution of benefits in society is regarded as acceptable. However, benefits in society
 should be allocated so that the benefits of the poorest person are maximized. Rawlsianism
is based on the idea that no one knows where they will end up on the social ladder,
therefore, society should aim to maximize the benefits of the poorest person (also known
as ‘maximin’) (Wonderling et al, 2005).

III. Analysis

A crucial ethical conundrum is captured by the conflict between efficiency and equity in the
distribution of resources in the healthcare system. In order to achieve equity, all people must
have fair and equitable access to healthcare, addressing systemic gaps that frequently result in
disadvantaged populations. Efficiency, on the other hand, emphasizes results and
cost-effectiveness while concentrating on optimizing the health benefits obtained from scarce
resources. This contradiction poses a serious problem since policies that prioritize equity may not
always be the most resource-efficient, while those that prioritize efficiency may unintentionally
prolong or worsen inequities. This struggle was best illustrated by the COVID-19 pandemic,
which forced healthcare systems around the world to decide which treatments and vaccines were
most important.

While Utilitarianism, Egalitarianism, Libertarianism, and Rawlsianism are ethical theories that
offer direction, but they also highlight how difficult it is to strike a balance. To ensure fair and
optimal healthcare delivery, effective solutions must integrate data-driven techniques, transparent
triage protocols, and community engagement. Therefore, to design resilient, inclusive, and
effective healthcare systems, overcoming these ethical problems necessitates a deep grasp of
both moral principles and practical limits.

IV. Recommendation

To effectively navigate the ethical dilemmas of balancing equity and efficiency in contemporary
healthcare resource allocation, the implementation of policy frameworks should address both
principles of equity and efficiency. Policies should combine efficiency-driven tactics like
cost-effective use of resources with equity-focused initiatives like targeted interventions for
marginalized populations. Secondly, utilize multi-criteria decision analysis (MCDA) instruments
to assess and resolve various ethical and utilitarian factors, guaranteeing clear and
knowledgeable decision-making. Third, create and improve triage procedures that are based on
moral principles and community involvement to make sure that choices are just and generally
acknowledged. Fourth, use data analytics to find gaps and direct resources to places where they
are most needed, maximizing efficiency and equity. Finally, in order to increase confidence and
adaptability in healthcare systems, promote ongoing communication among stakeholders,
including the public, the government, and healthcare professionals.
 V. Conclusion

Navigating the ethical dilemmas of healthcare resource allocation requires balancing the
principles of equity and efficiency. Equity and efficiency principles that are contrasted in the
issues should be combined in balance. Striking this balance is essential to creating reasonable
and practical policies, especially during emergency situations. In order to ensure that everyone
has the chance to reach optimal health, ethical frameworks and practical techniques must change
to meet the complexity of modern healthcare. Governments may build more equitable and
resilient healthcare systems by including efficiency and equity concerns.

VI. Message to Professor

Dear Sir Stranger,

I would like to take this moment to express my sincere gratitude and appreciation for your
support and dedication in teaching us and shaping us to be better individuals through our subject
Ethics. Your guidance and expertise have been instrumental in each of our academic journeys,
and I am deeply appreciative of the time and effort you have invested in us. With you being our
professor in Ethics has been truly inspiring. You have made learning exciting and interesting
with your approach in teaching. Thank you for being an exceptional mentor and for being
available to offer advice and assistance to each and every one of us. I wish you all the best.

With heartfelt appreciation,

Riri
References

Balancing Equity and Efficiency | Health Knowledge. (n.d.).

https://www.healthknowledge.org.uk/public-health-textbook/medical-sociology-policy-economic
s/4c-equality-equity-policy/balancing-equity-efficiency?fbclid=IwAR2NO2WXU2w8r-
WZY-Br87NwwBeZA9M3O8xFHYpsEmUgAxIuHq-UfhkvmmQ

Health Care Access - MU School of Medicine. (n.d.).

https://medicine.missouri.edu/centers-institutes-labs/health-ethics/faq/health-care-access

Team, S. (2024, April 19). Ethical Issues in Healthcare & Medical Challenges | Sermo. Sermo.
https://www.sermo.com/resources/ethical-issues-in-healthcare/?fbclid=IwAR3E24ebWO9arBHu
uVbbFkcYUZ4XNbF67pFMb1eC4OVB3MWh4cjpjSJbqxk#:~:text=2.-,Patient%20Confidential
ity,is%20patient%20privacy%20and%20confidentiality

Wonderling D., Gruen R., Black N. (2005). Introduction to Health Economics. Understanding
Public Health Series. Open University Press: London School of Hygiene and Tropical Medicine.