Benedict Rumbold

Universal health coverage, priority setting, and the human right to health

As health policy-makers around the world seek to make progress towards universal health coverage they must navigate between two important ethical imperatives: to set national spending priorities fairly and efficiently; and to safeguard the right to health. These imperatives can conflict, leading some to conclude that rights-based approaches present a disruptive influence on health policy, hindering states’ efforts to set priorities fairly and efficiently. Here, we challenge this perception. We argue first that these points of tension stem largely from inadequate interpretations of the aims of priority setting as well as the right to health. We then discuss various ways in which the right to health complements traditional concerns of priority setting and vice versa. Finally, we set out a three-step process by which policy-makers may navigate the ethical and legal considerations at play.

Improving productive efficiency in hospitals: findings from a review of the international evidence

At present, health systems across Europe face the same challenges: a changing demographic profile, a rise in multi-morbidity and long-term conditions, increasing health care costs, large public debts and other legacies of an economic downturn. In light of these concerns, this article provides an overview of the international evidence on how to improve productive efficiency in secondary care settings. Updating and expanding upon a recent review of the literature by Hurst and Williams (2012), we set out evidence on potential interventions in the policy environment, hospital management, and operational processes. We conclude with five key lessons for policy makers and practitioners on how to improve productive efficiency within hospital settings, and identify several gaps in the existing evidence base.

The importance of being NICE

Annette Rid, Peter Littlejohns, James Wilson, Benedict Rumbold, Katharina Kieslich and Albert Weale Department of Social Science, Health & Medicine, King’s College London, Strand, London WC2R 2LS, UK Department of Primary Care and Public Health Sciences, King’s College London, Weston Street, London SE1 3QD, UK Department of Philosophy, University College London, London WC1E 6BT, UK Department of Political Science, University College London, London WC1H 9QU, UK Corresponding author: Annette Rid. Email: annette.rid@kcl.ac.uk

Review article: the moral right to health: a survey of available conceptions

In recent years, there has been increasing recognition of both the philosophical questions engendered by the idea of a human right to health and the potential of philosophical analysis to help in the formulation of better policy. In this article, I attempt to locate recent work on the moral right to health in a number of historically established conceptions, with the aim of providing a map of the conceptual landscape as to the claims expressed by such a right.

Cost effective but unaffordable: an emerging challenge for health systems

New “budget impact test” is an unpopular and flawed attempt to solve a fundamentally political problem

Public Reasoning and Health-Care Priority Setting: The Case of NICE

ABSTRACT:Health systems that aim to secure universal patient access through a scheme of prepayments—whether through taxes, social insurance, or a combination of the two—need to make decisions on the scope of coverage that they guarantee: such tasks often falling to a priority-setting agency. This article analyzes the decision-making processes at one such agency in particular—the UK’s National Institute for Health and Care Excellence (NICE)—and appraises their ethical justifiability. In particular, we consider the extent to which NICE’s model can be justified on the basis of Rawls’s conception of “reasonableness.” This test shares certain features with the well-known Accountability for Reasonableness (AfR) model but also offers an alternative to it, being concerned with how far the values used by priority-setting agencies such as NICE meet substantive conditions of reasonableness irrespective of their procedural virtues. We find that while there are areas in which NICE’s processes may be improved, NICE’s overall approach to evaluating health technologies and setting priorities for health-care coverage is a reasonable one, making it an exemplar for other health-care systems facing similar coverage dilemmas. In so doing we offer both a framework for analysing the ethical justifiability of NICE’s processes and one that might be used to evaluate others.

Towards a More Particularist View of Rights’ Stringency

For all their various disagreements, one point upon which rights theorists often agree is that it is simply part of the nature of rights that they tend to override, outweigh or exclude competing considerations in moral reasoning, that they have ‘peremptory force’ (Raz in The Morality of Freedom, Oxford University Press, Oxford, 1986, p. 192), making ‘powerful demands’ that can only be overridden in ‘exceptional circumstances’ (Miller, in Cruft, Liao, Renzo (eds), Philosophical Foundations of Human Rights, Oxford University Press, Oxford, 2016, p. 240). In this article I challenge this thought. My aim here is not to prove that the traditional view of rights’ stringency is necessarily false, nor even that we have no good reason to believe it is true. Rather, my aim is only to show that we have good reason to think that the foundation of the traditional position is less stable than we might have otherwise supposed and that an alternative conception of rights—one which takes the stringency of any given right as particular to the kind of right it is—is both viable and attractive. In short, to begin to move us towards a more ‘particularist’ conception of rights’ standing in moral reasoning and judgement.

Spinoza’s genealogical critique of his contemporaries’ axiology

ABSTRACT Among Spinoza’s principal projects in the Ethics is his effort to “remove” certain metaethical prejudices from the minds of his readers, to “expose” them, as he has similar misconceptions about other matters, by submitting them to the “scrutiny of reason”. In this article, I consider the argumentative strategy Spinoza uses here – and its intellectual history – in depth. I argue that Spinoza’s method is best characterised as a genealogical analysis. As I recount, by Spinoza’s time of writing, these kinds of arguments already had a long and illustrious history. However, I also argue that, in his adoption of such strategies, we have good reason to think Spinoza’s primary influence was Gersonides. Elucidating this aspect of Spinoza’s critique of his contemporaries’ axiologies brings a number of explicatory and historical boons. However, regrettably, it also comes at a cost, revealing a significant flaw in Spinoza’s reasoning. Towards the end of this article, I consider the nature of this flaw, whether Spinoza can avoid it and its ramifications for Spinoza’s wider philosophical project.