Are resources controlled by third party gatekeepers distributed equitably?
A timely example we should all discuss is this:
commonly occurring saline bag shortages at hospitals.
When an epidemic such as coronavirus hits, severe shortages are a deadly certainty.
Commodity supplies in hospitals are purchased through GPOs.
GPOs are given safe harbor exemption from federal anti-kickback law, and so are permitted shrouds of secrecy surrounding pricing and allocations policy (and this is fiercely protected by Congress).
Therefore:
Hospitals in ‘flyover country’ may or may not receive the same allocations per capita (of saline bags) from huge profitable GPOs as the GPOs allocate to hospitals in districts where their Congressional champions reside.
Taxpayers simply have no way to discover resource allocation policy or whether equitable distribution policy is overlooked for favorable relationships–remember that Anti-Kickback law doesn’t apply to GPOs.
The following exerpt is from an analysis of medical resource allocations:
“Therefore, although society’s conferral of a service monopoly may have considerable benefit for the monopoly holder, its ultimate aim is not to advantage the monopoly holder but to benefit society and its individual members.
Therefore, the fact that the profession of medicine is a service-provider monopoly means that the profession has a duty to ensure not merely that the quality of medical services is as good as possible, but also that there is equitable access to the services that can be provided only by its members, and that the rules under which the resources that are controlled by the profession are provided are applied equitably. The crucial term here is “equitably”. “
Resource Allocation in Healthcare: Implications of Models of Medicine as a Profession
Eike-Henner W. Kluge, PhD
MedGenMed. 2007; 9(1): 57.
Published online 2007 Mar 21.
PMCID: PMC1925021
PMID: 17435657
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1925021/