Death and dignity - Terminal illness and the market for non-treatment

• 成果类型: Article
• 署名作者: Byrne, MM; Thompson, P
• 署名单位: Baylor College of Medicine; University of Houston System; University of Houston
• 刊物名称: JOURNAL OF PUBLIC ECONOMICS
• ISSN/ISSBN: 0047-2727
• DOI: 10.1016/S0047-2727(99)00047-X
• 发表日期: 2000
• 页码: 263-294
• 关键词: Health care; quality of life; health insurance; terminal illness; health expenditures

摘要

We construct a stochastic model of illness, death and treatment choice to analyze two proposals - legally-binding advance directives and insurer-paid compensation schemes - to reduce the incidence of aggressive and possibly futile end-of-life treatment. We assess whether, in a competitive insurance market, the proposals are consistent with (i) individual rationality in selection of competitive insurance contracts; (ii) medically ethical treatment provision, and (iii) reductions in end-of-life expenditures. We conclude that binding advance directives are always medically unethical, while compensation schemes are medically ethical. We derive the compensation schedule arising in a competitive equilibrium, and show that it reduces aggressive treatment and satisfies individual rationality. (C) 2000 Elsevier Science S.A. All rights reserved.