MEANING AND

SERVICE
VALUE OF
MEDICAL CARE
ALLOCATION OF
HEALTH
RESOURCES
GOAL

To gain an understanding of our current national

health care crisis and to examine potential solutions
under the principle of justice.
FORMAL AND MATERIAL JUSTICE

• The fair and equitable division of scarce goods and services is usually
considered an issue of distributive justice.
• The requirements of formal justice, as attributed by Aristotle, are that
in distribution, equals must be treated equally, and unequals must be
treated unequally. Formal justice does not attempt to provide any
criteria for the determination of equality and does not state in what
respect equals are to be treated, except that they must be treated equally.
• Under formal justice, any criteria could be used---age, sex,
marital status, land ownership--- provided the criteria were
applied equally in all similar cases.
• Principles that specify relevant characteristics or morally
relevant criteria in regard to treatment are said to be
material principles and form the basis of material justice.
COMMON METHODS FOR DISTRIBUTING
OF GOODS AND RESOURCES
To each person an equal share
To each person according to need
To each person according to merit
To each person according to contribution
To each person according to effort
To each person according to social worth
• The least ethically acceptable rationing criteria would be those that placed
individuals or groups disadvantaged by poverty or incapacitated by illness in
the lowest priority.
• Discrimination between classes of people is morally justified only if
properties that can be overcome.
• The attempt to treat all equally is formulated in the fair opportunity rule,
which holds that no persons should be granted social benefits on the basis of
underserved disadvantages.
MICRO- AND
MACRO
ALLOCATION OF
HEALTH CARE
MACRO ALLOCATION
• Usually the province of Congress, state legislatures, insurance companies,
private foundations, and health organizations as society attempts to determine
how much should be expended and what kinds of goods and services will be
made available.
• Macro-allocation problems are demonstrated in such questions as:
What kinds of health care will be available?
Who will get it, and on what basis?
How will the costs be distributed?
Who will deliver the services?
Who controls these issues?
• Deals with the larger societal issues of what
kinds of health care will be provided to the
citizens as a whole
MICRO-ALLOCATION

• Deals with the personal determination of who will receive

scarce resources.
• Triage system that evaluate medical utility issues (such as
best prognosis) seem more acceptable than system such as
social utility, in which there is a subjective determination of
an individual’s worth in making these decisions.
THEORIES OF JUSTICE

• Several theoretical positions have been advance in the debate over

the allocation of health care resources.
– Egalitarianism
– Utilitarianism
– Libertarianism
EGALITARIAN THEORIES

• Emphasize equal access to goods and services.

• Egalitarian thinkers believe that an affluent society such as ours
must find a way to provide universal health care to all its citizens. It
is within the egalitarian end of the spectrum that the advocates of a
right to health care are most comfortable.
• These thinkers hold that any deviation from absolute equality in
distribution is unjust.
UTILITARIAN THEORIES

• These theories emphasize a mixture of criteria so that public utility

is maximized.
• Public utility is defined in the phrase “the greatest good for the
greatest number.”
• Generally accept political planning and intervention as methods of
redistributing goods and wealth to bring about public utility.
LIBERTARIAN THEORIES

• Libertarians emphasize personal rights to social and economic liberty. They

are not as concerned with, nor do they outline the requirements of how the
material goods and services are to be distributed, only that the choice of
allocation system be freely chosen.
• Some have used the free-market approach. This has recently been criticized
as it has not created unified system of health care delivery within our nation
but a whole series of micro systems, some of which work well and others
that appear broken.