xxxvii, 276 pages : illustrations ; 24 cm
9780199559978 hardback 019955997X hardback
"Societies make decisions and take actions that profoundly impact the distribution of health. Why and how should collective choices be made, and policies implemented, to address health inequalities under conditions of resource scarcity? How should societies conceptualize and measure health disparities, and determine whether they've been adequately addressed? Who is responsible for various aspects of this important social problem? In Health and Social Justice, Jennifer Prah Ruger elucidates principles to guide these decisions, the evidence that should inform them, and the policies necessary to build equitable and efficient health systems world-wide. This book weaves together original insights and disparate constructs to produce a foundational new theory, the health capability paradigm." "Ruger's theory takes the ongoing debates about the theoretical underpinnings of national health disparities and systems in striking new directions. It shows the limitations of existing approaches (utilitarian, libertarian, Rawlsian, communitarian), and effectively balances a consequentialist focus on health outcomes and costs with a proceduralist respect for individuals' health agency. Through what Ruger calls shared health governance, it emphasizes responsibility and choice. It allows broader assessment of injustices, including attributes and conditions affecting individuals' "human flourishing," as well as societal structures within which resource distribution occurs. Addressing complex issues at the intersection of philosophy, economics, and politics in health, this fresh perspective bridges the divide between the collective and the individual, between personal freedom and social welfare, equality and efficiency, and science and economics."--BOOK JACKET.
Bibliography, etc. Note
Includes bibliographical references (pages -270) and index.
Formatted Contents Note
Approaches to medical and public health ethics. Welfare economic and utilitarian approaches ; Communitarianism and liberal communitarianism ; Egalitarian theories : equal opportunity and equal welfare ; Libertarian and market-based approaches ; Deliberately democratic procedures ; Summary of problems with the current set of frameworks Health and human flourishing. Aristotle's theory ; The capability approach ; Capability and health policy Pluralism, incompletely theorized agreements, and public policy. Social choice theory, collective rationality, and Arrow's impossibility result ; Incompletely theorized agreements ; Incompletely specified agreements ; Incompletely specified and generalized agreements ; Incompletely theorized agreements on particular outcomes ; Incompletely theorized agreements and public policy ; Pluralism, ambiguity, and incompletely theorized agreements ; Incompletely theorized agreements and health capability ; Health capability set : central and non-central health capabilities Justice, capability, and health policy. Trans-positionality : a global view of health ; Equality, sufficiency, and priority ; Efficiency and health policy ; Ethics of the social determinants of health ; Limitations and objections ; Principles of the health capability paradigm Grounding the right to health. Scope and content of a right to health ; Duties and obligations in domestic and international policy and law : ethical commitments and public moral norms ; Positive and negative rights : a constitutional right to medical self-defence Health capability account of equal access. Rethinking equal access : agency, quality, and norms. High-quality care and a two-tiered system ; Responsibility and health : voluntary risk compared with involuntary risk ; Paternalism, libertarian paternalism, and free will A health capability account of equitable and efficient health financing and insurance. Theory of demand for health insurance ; Behavioural economics and prospect theory ; Medical ethics and equal access to health care ; Welfare economics and the capability approach ; Vulnerability and insecurity ; Moral foundations of health insurance ; Gains in well-being from risk pooling and health insurance ; Gains in well being from risk pooling and health insurance ; Empirical evidence on the equity of health financing models ; Market failures, public goods, and the role of the public sector Allocating resources : a joint scientific and deliberative approach. Reasoned consensus through scientific and deliberative processes ; Frameworks for combining technical and ethical rationality for collective choice ; Allocations withing the broader social budget ; Allocating within the health policy budget : benefits package : types of goods and services guaranteed ; An evidence-based approach : medical appropriateness and clinical practice guidelines ; Medical futility and setting limits ; Universal benefits package ; Hard cases : the 'bottomless pit objection' and 'reasonable accommodation' ; Joint clinical and economic solutions : incorporating efficiency ; Resource allocation and age : reaching the highest average life expectancy Political and moral legitimacy : a normative theory of health policy decision-making. Public moral norms and domestic health reforms ; Norms and values in the public's assessment of policy ; alternative frameworks : political conceptions and political processes ; Case study : the Clinton administration and failed health reform ; A model of American health care reform and incomplete theorization ; A wedge theory of health care reform ; Internalization and agreement on moral values.
K3570 .R84 2010
Oxford ; New York : Oxford University Press,