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Coursera – Rationing and Allocating Scarce Medical Resources


Published on: December 10, 2020
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This course will explore the complex challenges of allocating scarce medical resources at both the micro and macro level. Students will learn the theories behind allocation and use modern examples to explore how society makes the difficult decisions that arise when there is not enough to go around.

You have one liver but three patients awaiting a liver transplant. Who should get the liver? What criteria should be used to select the recipient? Is it fair to give it to an alcoholic? These are some of the questions that arise in the context of rationing and allocating scarce health care resources among particular individuals, and concern what are called micro-allocation decisions. But trade-offs also need to be made at the meso- and macro-level. Budgets of public payers of healthcare, such as governments, and of private ones, such as health plans, are limited: they cannot cover all drugs and services that appear beneficial to patients or physicians. So what services should they provide? Is there a core set of benefits that everyone should be entitled to? How can we make fair decisions, if we know from the outset than not all needs can be met? Using the cases of organs for transplantation, the rationing for vaccines in a flu pandemic, and drug shortages, the course will critically examine alternative theories for allocating scarce resources among individuals, while also exploring the principles and values that underlie those theories.

Logistics and Grading

This class is seven weeks long. Each week, students will watch approximate 30 – 40 minutes of lectures by Dr. Emanuel. Students should expect to spend 2 – 5 hours per week reading related materials from the reading list, all of which are freely accessible online.

Students taking the course for a grade will complete one quiz (also referred to throughout the course as a peer assessment) per week, which will be peer-graded based on a detailed answer key provided after the due date. Of the seven scores earned for assignments, the lowest two scores will be dropped in calculating the final grade. The remaining five scores will be weighted equally. As a result, students who miss a homework assignment can still earn full credit in the course. There are no exams or final projects in this course. Students not taking the course for a grade may choose not to complete the assignments.

The details of these logistics are subject to change; if changes are made, students will be notified via an announcement and this page will be updated.


Week 1: “Who Gets the Liver?? & History of Rationing
We begin the course with a hypothetical case. We have one liver and three patients who will die if they don’t get a transplant. We will discuss some of the potential approaches for making life and death decisions in the context of absolute scarcity. Next we will explore the history of rationing in medicine. Absolute scarcity has always been a problem. How have we dealt with this problem in the past? We’ll take a look at what happened in the cases of three major 20th century medial advances: insulin, penicillin, and dialysis.

Week 2: Conceptual Distinctions
The study of rationing was borne out of the concept of absolute scarcity in medicine-cases in which the demand for medical care far exceeds the resources existing to meet that need. Because demand will inevitably exceed supply-no matter what-choices must be made about which patients receive treatment, and which don’t. But what do we really mean when we use the term ‘rationing?’ Is there a difference between the terms rationing, resource allocation, and priority-setting? In this lecture, we will attempt to explain the conceptual distinctions that give meaning to the terms we use in this course.

Week 3: Organs for Transplantation
Kidneys, livers, hearts, and lungs are among the most discussed absolutely scarce medical resources. And thei


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