Theories of justice

“Justice”, in the everyday sense, can be defined as a “fair balance of interests”. People or actions can be “just” or “unfair”, as can states, legal norms or game results. The economy deals with goods and therefore also with their distribution. Such distributions can be seen as fair or unfair. Therefore, the economy can also be considered from the point of view of justice.

The idea of fairness is of great relevance for health economics. Depending on what kind of theory of justice you prefer, and how far you are willing to go in supporting one view to the exclusion of others, you will end up with completely different solutions to the problem of allocating health services.

For example, if you strongly believe that everybody should be given free choice and every person should act on their own will without compulsion and be responsible for themselves, then you will opt for a private healthcare system in which everybody is free to purchase whatever kind of service or insurance they want and can afford at whatever price the market provides. Of course, you will have to accept that many people will suffer or even die because they cannot pay for the treatment they need.

If you think, however, that every person should be protected from illness and dealing with the threat of catastrophic medical bills is a collective social responsibility, you will opt for a healthcare system in which everybody is entitled to receive the treatment they need at a price they can afford.

And if you think that fairness in healthcare merely involves maximizing total gain from health spending, you will allocate resources to the people who gain the most health per unit of cost, which may imply denying effective care to people who gain the least health per unit of cost. The important point here is that there is no such thing as the best healthcare system. Rather, it depends on your idea of “justice”.

The debate over justice also suffers from the complexities of definition. Justice deals with the rights and wrongs of power.