Equity in health and health care is animportant issue. It has been proposed that thepursuit of equity in health care is beinghampered by the dominance of individualism inhealth care practices. This paper explores theway in which communitarian ideals and practicesmight lend themselves to the pursuit of equity.Communitarians acknowledge, respect and fosterthe bonds that unite and identify communities.The paper argues that, to achieve equity inhealth care, these bonds need to be recognisedand harnessed rather than ignored. The notionof individual autonomy in the (...) context of thecommunity is examined. Alternative concepts ofautonomy – social autonomy and communityautonomy – are seen to be more respectful andnurturing of both the individual and thecommunity. Moreover, these concepts appeardesirable for the pursuit of health care equitygoals. The paper concludes with some thoughtsabout how equity in Australia's health caresystem can reasonably progress within acommunitarian vision. Disadvantaged communitiesare discussed throughout, in particular,Australian Aboriginal communities. (shrink)

Most of the debate surrounding standards in medical care, issues of medical audit and what constitutes benefit from health care assumes that what is obtained from health care is health and only that. This is an assumption which most health economists at least implicitly appear to endorse. This paper questions that assumption. There are various outcomes beyond health and there are various processes involved in health care about which patients are not indifferent. This paper calls for a fuller investigation as (...) to what it is that patients want from their health services and the adoption of a more pluralistic conception of health care benefits. It is further argued that the objectives of health care systems are those in which citizensqua citizens also have interests and which may be different from those of patients. It is yet less likely that citizens’ interests in health care will be restricted to health. (shrink)

This study is part of a programme to elicit and examine community preferences for health care in different contexts. Data were obtained from a group of predominantly Australian health care decision-makers. A short questionnaire contained six valuation questions and four demographic questions. The six valuation questions posed choices where equal health gains were to be allocated to different population groups based upon: age; sex; current health; socio-economic status; across time; and across different numbers of individuals. The results provide some evidence (...) that respondents were prepared to discriminate between health gains derived in different contexts especially where health gains were to be allocated between groups of different health status and over time. Further research is planned and the possible implications for health policy, and in particular for resource allocation in health care, are briefly discussed. (shrink)

This book comprises an attempt to examine how we might set about an- swering the question: How much is society prepared to pay to reduce mortality: Or more brutally, what is the value of human life? The justification for attempting to answer such questions lies in the de- sirability of injecting increased explicitness and rationality into decision-making in those areas of the public sector which are con- cerned with life saving. Given that resources are already being de- ployed to such (...) activities as crash-barriers on motorways, helicopters for air-sea rescue, kidney machines and other life-saving measures - although such activities result only in a reduction in risk of death, not itsillimination, in the policy fields affected - this means that already at the present time, at least by implication, values are be- ing placed by decision-makers on the saving of life. (shrink)

This paper introduces this mini-series on vertical equity in health care. It reflects on the fact that by and large equity policies in health care have failed and that there is a need for positive discriminationto promote equity better in future. This positive discrimination is examined under the heading of`vertical equity'. The paper considers Varian's notion of 'envy' as a basis for equity in health care but concludes that this is not a helpful route to go down. Better it would (...) seem to pursue the idea from Sen of 'freedoms' and 'communitarian claims' (as raised previously by this author). While it is argued that procedural justice is to be preferred in the longer run as a basis for equity there are gains in adopting a short run goal of promoting distributive justice. Some preliminary evidence is presented on the weighting of health gains to reflect such vertical equity concerns. (shrink)

This paper argues that there is a need to move yet further than has already been suggested by some from the individual to the collective as a base for public health. A communitarian approach is one way to achieve this. This has the advantage of allowing not only the community’s voice to have a say in setting the values for public health but also more formally the development of a constitution on which public health might then be built. It also (...) sees public health as a social institution which can be valued in its own right. (shrink)

Providing health care in the most cost-effective way has become a priority in recent years. This book tackles the important issue of the potential conflict between economic expediency and the welfare of individual patients. Contributors examine different attitudes to this complex problem, along with a variety of legal and historical perspectives. The book addresses particular aspects of health care, such as medical expert systems, general practice, medical education, and clinical decision-making where the direct involvement of doctors in allocating scarce and (...) expensive resources is perhaps most obvious. (shrink)

Effectiveness, efficiency and equity in health care are discussed in this article against the background of concerns that cost containment may lead to reductions in quality of care. It is suggested that effectiveness is best seen from the patient's point of view and that it relates to more than simply improved health status. Efficiency and equity are better viewed from a societal stance.The paper discusses the role of the medical profession in effectiveness, efficiency and equity and argues that the role (...) of medical doctors needs to be constrained. (shrink)

Most of the debate surrounding standards in medical care, issues of medical audit and what constitutes benefit from health care assumes that what is obtained from health care is health and only that. This is an assumption which most health economists at least implicitly appear to endorse. This paper questions that assumption. There are various outcomes beyond health and there are various processes involved in health care about which patients are not indifferent. This paper calls for a fuller investigation as (...) to what it is that patients want from their health services and the adoption of a more pluralistic conception of health care benefits. It is further argued that the objectives of health care systems are those in which citizensqua citizens also have interests and which may be different from those of patients. It is yet less likely that citizens’ interests in health care will be restricted to health. (shrink)

This book addresses an intruiging question: What do we mean by justice in health care? It concentrates on the social level of decision-making rather than the individual decisions which are more commonly the subject of medical ethics.