Equity, Autonomy, and Efficiency: What Health Care System Should We Have?
Menzel, Paul T.
Journal of Medicine and Philosophy. 1992 Feb; 17(1): 33-57.
The U.S. has a wide range of options in choosing a health care system. Rational choice of a system depends on analysis and prioritization of the basic moral goals of equitable access to all citizens, the just sharing of financial costs between well and ill, respect for the values and choices of subscribers and patients, and efficiency in the delivery of costworthy care. These moral goals themselves, however, tell us little about what health care system the United States should have. Equitable access does not demand a level and scope of care for the poor equal to that rationally chosen by the middle class, and there are ways within mixed systems, though not easy ways, to achieve a fair distribution of costs between well and ill. Despite pluralistic systems' apparent advantage in allowing subscribers to choose their own forms of rationing, problems in translating serious long-term subscriber choices into actual medical practice may be greater in pluralistic than in unitary systems. Final choice of a system hinges primarily on peculiar historical facts about U.S. political culture, not on moral principle.
Alternatives; Autonomy; Beneficence; Caring; Costs and Benefits; Culture; Economics; Employment; Evaluation; Federal Government; Financial Support; Forms; Freedom; Goals; Government; Health; Health Care; Health Care Delivery; Health Insurance; Indigents; Industry; Insurance; Justice; Life; Mandatory Programs; Moral Policy; Patients; Policy Analysis; Public Policy; Resource Allocation; Socioeconomic Factors; Value of Life; Values; Voluntary Programs;
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Menzel, Paul T. (2003-06)In their normative role in shaping the basic structure of a health care system, liberty and equality are often thought to conflict so sharply that health policy is condemned to remain an ideological battleground. In this ...