Health Care Analysis 25 (2):114-137 (2017)

Authors
Lynette Reid
Dalhousie University
Abstract
Some argue that the concept of medical need is inadequate to inform the design of a universal health care system—particularly an institutional rather than a residual system. They argue that the concept contradicts the idea of comprehensiveness; leads to unsustainable expenditures; is too indeterminate for policy; and supports only a prioritarian distribution. I argue that ‘comprehensive’ understood as ‘including the full continuum of care’ and ‘medically necessary’ understood as ‘prioritized by medical criteria’ are not contradictory, and that UHC is a solution to the problem of sustainability, not its cause. Those who criticize ‘medical need’ for indeterminacy are not transparent about the source of their commitment to their standards of determinacy: they promote standards that are higher than is necessary for legitimate policy, ignoring opportunity costs. Furthermore, the indeterminacy of concepts affects all risk-sharing systems and all systems that rely on medical standard of care. I then argue that the concept of need in itself does not imply a minimal sufficientist standard or a prioritarian distribution; neither does the idea of legitimate public policy dictate that public services be minimalist. The policy choice for a system of health care that is comprehensive and offers as good care as can be achieved when delivered on equal terms and conditions for all is a coherent option.
Keywords Medical need  Resource allocation  Health systems  Universal health care  Public health ethics  Health policy/ethics
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DOI 10.1007/s10728-016-0325-3
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References found in this work BETA

Equality, Priority, and Compassion.Roger Crisp - 2003 - Ethics 113 (4):745-763.
Needs, Values, Truth: Essays in the Philosophy of Value.David Wiggins - 1987 - Oxford, England and Cambridge, MA, USA: Oxford University Press.
Fairness.John Broome - 1991 - Proceedings of the Aristotelian Society 91:87 - 101.

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