During our GH discussions, the idea of “value” has presented itself on a multitude of occasions. Inevitably, the meaning of value shifts dramatically depending on the population at hand. For health care providers, the term value is likely attached to some notion of guideline based medical treatment, but can take on a whole different meaning when a patient’s perspective is used. Out of our Farmer et al. discussion, emerged the topic of direct cash transfer and the potential for different view/amounts of value placed on methods of reducing poverty.
Broadly, direct cash transfers and subsidies are measures governments take in attempts to alleviate poverty. Direct cash transfers have been used throughout Central America, Asia and Africa and in my opinion, are a way for citizens to have more control over what they place value on in certain aspects of their lives. For example, as providers when we see patients in the clinic with stable CAD, we interpret certain medical treatments as providing value to the patient, but this may not be equivalent to how a patient would define value. If the patient is unable to provide secure housing, food or education to his/her children, the relevance or value of being on aspirin and a beta-blocker may be diminished to them. Instead, if they received a direct cash transfer from the government and were able to purchase food, livestock or repair a leaky roof, they would likely place more value in those purchases and ultimately be more apt to adhere to the medical treatments in the future that providers place so much value on.
Opponents of the direct cash transfer may express concern that people are likely to squander these sums of money and in the end, may be no further ahead than when they started. This could certainly occur, but people have the right to make their own decisions, no matter how flawed. Additionally, I imagine that the majority of people would welcome the direct cash transfer and spend it responsibly on things they would derive the most benefit from. Also, by either replacing direct cash transfers with a more government regulated method or by restricting how the direct cash transfers are spent, the assumption is that the government knows better than its people in terms of improving their quality of life and also continues to promote a sense of outdated paternalism.
In closing, there is no perfect way to reduce poverty, but I think direct cash transfers will be able to alleviate some of the burden and allow individuals to maintain their values.