Skip to main content Accessibility help
Hostname: page-component-cf9d5c678-5tm97 Total loading time: 0.233 Render date: 2021-07-28T02:01:42.792Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

Rawlsian Justice and the Financing of the National Health Service

Published online by Cambridge University Press:  20 January 2009

Claudine McCreadie
Honorary Research Fellow, Centre for Studies in Social Policy.


John Rawls' A Theory of Justice was published in Britain in 1972. The summation of many years' work by Professor Rawls, it has stimulated widespread admiration and criticism. In this article Rawls' theory is summarized briefly together with some of the major criticisms that have been made of it. An attempt is then made to apply one of Rawls' principles of justice to the question of health services financing, using as a case study the recommendations of an advisory panel of the British Medical Association, which reported in 1970. These recommendations involved extending the private sector in medical care, on the argument that the flow of resources to the National Health Service would increase and, despite possible greater inequalities, result in an improvement in the level of care for all. Judged by the Rawlsian principle, these recommendations are not found likely to represent a just solution to the question of health service financing.

Copyright © Cambridge University Press 1976

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


1 Rawls, John, A Theory of Justice, Oxford: Clarendon Press, 1977.Google Scholar

2 British Medical Association, Health Services Financing: a Report Commissioned in 1967 by the BMA and Carried Out by an Advisory Panel under the Chairmanship of Dr I. M. Jones, London: British Medical Association, 1970.Google Scholar

3 Titmuss, Richard M., Social Policy: an introduction, London: Allen & Unwin, 1974.Google Scholar

4 Rein, Martin, ‘Social Policy Analysis as the Interpretation of Beliefs’, Journal of the American Institute of Planners, 09 1971, col. 37, pp. 297310.CrossRefGoogle Scholar

5 Rawls, , op. cit., p. 15.Google Scholar

6 Ibid., p. 60

7 Ibid., p. 83.

8 Ibid., p. 305.

9 Ibid., p. 78.

10 See for example: Barry, Brian, The Liberal Theory of Justice, Oxford: Clarendon Press, 1973Google Scholar; Campbell, T. D., Review in Political Quarterly, 1012 1972, vol. 43, no. 4, pp. 510–12Google Scholar; Flew, Anthony, Review in Journal of Social Policy, 10 1973, vol. 2, pt. 4, pp. 357–9Google Scholar; Hare, R. M., ‘Rawls' Theory of Justice’, Philosophical Quarterly, 07 1973, vol. 23, pp. 144–55 and 09 1973, vol. 23, pp. 241–52Google Scholar; Haksar, V., Review Article: ‘Autonomy, Justice and Contractarianism’, British Journal of Political Science, 10 1973, vol. 3, pp. 487509Google Scholar; Nagel, T., ‘Rawls on Justice’, Philosophical Review, 1973, vol. 82, pp. 220–34Google Scholar; Nisbet, R., ‘The Pursuit of Equality’, The Public Interest, Spring 1974, no. 35, pp. 103–20Google Scholar; Social Theory and Practice, Spring 1974, vol. 3.Google Scholar The whole issue of the latter is devoted to Rawls' work. See especially the contribution by Frankel, Charles, ‘Justice, Utilitarianism and Rights’Google Scholar, and by Schaar, John, ‘Reflections on Rawls' Theory of Justice’.Google Scholar

11 Nagel, , op. cit., p. 234.Google Scholar

12 Hare, , op. cit., p. 147.Google Scholar

13 Nagel, , op. cit., p. 224.Google Scholar

14 Ibid., p. 225.

15 Nisbet, , op. cit., p. 112.Google Scholar

16 Ibid., p. 113.

17 Nagel, , op. cit., p. 226.Google Scholar

18 Ibid., p. 227.

19 Rawls, , op. cit., p. 229.Google Scholar

20 Nagel, , op. cit., p. 233.Google Scholar

21 Nisbet, , op. cit., p. 114.Google Scholar

22 Rawls, , op. cit., p. 205.Google Scholar

23 Nisbet, , op. cit., p. 117.Google Scholar

25 Rawls, , op. cit., p. 25.Google Scholar

26 Schaar, , op. cit., p. 86.Google Scholar

27 BMA, op. cit., §6.45.Google Scholar

28 Ibid., §6.74 (my italics).

29 Rawls, , op. cit., p. 97.Google Scholar

30 Ibid., p. 15.

31 BMA, op. cit., § 6.38.Google Scholar

32 Perlman, M., Rationing of Medical Resources: Complexities of the Supply and Demand Problem, University of Keele, Sociological Review Monograph no. 14, 1969Google Scholar; Wirick, G. C. and Barlow, R., ‘The Economic and Social Determinants of the Demand for Health Services’, in Axelrod, J. S., The Economics of Health and Medical Care, Ann Arbor, Michigan: University of Michigan Press, 1964Google Scholar; Gough, I. R., ‘Poverty and Health: a Review article’, Social and Economic Administration, 07 1970, vol. 4, pp. 211–23.Google Scholar

33 Cf. Daw, R. H., ‘A Comparison of Mortality and Sickness in Relation to Geographical and Socio-economic factors’, Journal of the Institute of Actuaries, 1971, vol. 97, pp. 1767Google Scholar; Townsend, P., ‘Inequality and the Health Service’, The Lancet, 15 06 1974, vol. 1, no. 7868, pp. 1179–89.Google Scholar

34 Somers, H. M. and Somers, A. R., Doctors, Patients and Health Insurance, the Organization and Financing of Medical Care, Washington: Brookings Institution, 1961.Google Scholar

35 Brotherston, J., ‘Change and the National Health Service’, Scottish Medical Journal, 04 1969, vol. 14, pp. 130–44.CrossRefGoogle ScholarPubMed

36 BMA, op. cit., p. 379.Google Scholar

37 Ibid., §6.38.

38 Cf. Ginsberg, E. and Ostow, M., Men, Money and Medicine, New York: Columbia University Press, 1970.Google Scholar

39 Johnson, T. J., Professions and Power, London: Macmillan, 1972Google Scholar; Jamous, H. and Pelouille, B., ‘The French University Hospital System’, in Jackson, J. A., Professions and Professionalization, London: Cambridge University Press, 1970.Google Scholar

40 Rayack, E., ‘The American Medical Association and the Supply of Physicians’, Medical Care, 02 1965, vol. 3, pp. 1725.CrossRefGoogle Scholar

41 Kessell, R. A., ‘Price Discrimination in Medicine’, Journal of Law and Economics, 1958, vol. 1, pp. 2053Google Scholar; also Jamous, and Pelouille, , op. cit.Google Scholar

42 Arrow, K. J., ‘Uncertainty and the Welfare Economics of Medical Care’, American Economic Review, 12 1963, vol. 53, pp. 942–73Google Scholar; Sigerist, H., Civilization and Disease (chap, on ‘Disease and the Law’), Chicago: Chicago University Press, 1962.Google Scholar

43 BMA, op. cit., §6.23.Google Scholar

44 Aitken, R., ‘Financing the Health Service’, British Medical Journal, 25 04 1970, vol. 2, no. 5703, p. 229.CrossRefGoogle Scholar

45 Tobin, J., ‘On Limiting the Domain of Inequality’, Journal of Law and Economics, 10 1970, vol. 13, pp. 263–77.CrossRefGoogle Scholar

46 Smith, A. and Carstairs, V., Patients under Psychiatric Care in Hospital, Scotland, 1963Google Scholar; Edinburgh: Scottish Home and Health Department (Scottish Health Service Studies No. 1), quoted in Rein, M., ‘Social Class and the Utilization of Medical Care Services’, Hospitals, 07 1969, vol. 43, pp. 4354Google Scholar; Isaacs, B., Studies of Illness and Death in the Elderly in Glasgow, Edinburgh: Scottish Home and Health Department, 1971 (Scottish Health Service Studies No. 17)Google Scholar; Carstairs, V. and Patterson, P. E., ‘Distribution of Hospital Patients by Social Class’, Health Bulletin (Scottish Home and Health Department), 07 1966, vol. 24, pp. 5967.Google Scholar

47 For psychiatric illness see Bransby, E. R., ‘Mental Illness and the Psychiatric Services’, Social Trends, no. 4, London: HMSO, 1973.Google Scholar

48 Daw, , op. cit.Google Scholar

49 Rein, , op. cit.Google Scholar; Ashford, J. R. and Pearson, N. G., ‘Who Uses Health Services and Why?Journal Royal Statistical Society, Series A, 1970, vol. 133, part 33, pp. 295346Google Scholar; Office of Population Censuses and Surveys, Social Survey Division, General Household Survey, 1972, London: HMSO, 1975, Tables 5.28 to 5.30.Google Scholar

50 Royal Commission on the Distribution of Income and Wealth, Report no. 1: Initial Report on the Standing Reference, Cmnd. 6171, London: HMSO, 1975, chap. 4, p. 154.Google Scholar

51 Benjamin, B., Social and Economic Factors affecting Mortality, The Hague, 1965.Google Scholar

52 Dolman, D., Comment on Professor Lees' paper, ‘Social Services: Health’, Public Finance, 1967, vol. 22, nos. 1–2, pp. 190, 194.Google Scholar

Cited by

Send article to Kindle

To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Rawlsian Justice and the Financing of the National Health Service
Available formats

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Rawlsian Justice and the Financing of the National Health Service
Available formats

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Rawlsian Justice and the Financing of the National Health Service
Available formats

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *