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Ethics in American health 2: An ethical framework for health system reform

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  • Ruger, J.P.

Abstract

I argue that an ethical vision resting on explicitly articulated values and norms is critical to ensuring comprehensive health reform. Reform requires a consensus on the public good transcending self-interest and narrow agendas and underpinning collective action for universal coverage. In what I call shared health governance, individuals, providers, and institutions all have essential roles in achieving health goals and work together to create a positive environment for health. This ethical paradigm provides (1) reasoned consensus through a joint scientific and deliberative approach to judge the value of a health care intervention; (2) a method for achieving consensus that differs from aggregate tools such as a strict majority vote; (3) combined technical and ethical rationality for collective choice; (4) a joint clinical and economic approach combining efficiency with equity, but with economic solutions following and complementing clinical progress; and (5) protection for disabled individuals from discrimination.

Suggested Citation

  • Ruger, J.P., 2008. "Ethics in American health 2: An ethical framework for health system reform," American Journal of Public Health, American Public Health Association, vol. 98(10), pages 1756-1763.
    • Handle: RePEc:aph:ajpbhl:10.2105/ajph.2007.121350_1
    DOI: 10.2105/AJPH.2007.121350
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    Cited by:

    1. Regina Moczadlo & Harald Strotmann & Jürgen Volkert, 2015. "Corporate Contributions to Developing Health Capabilities," Journal of Human Development and Capabilities, Taylor & Francis Journals, vol. 16(4), pages 549-566, November.
    2. Erik Nord & Jose Luis Pinto & Jeff Richardson & Paul Menzel & Peter Ubel, 1999. "Incorporating societal concerns for fairness in numerical valuations of health programmes," Health Economics, John Wiley & Sons, Ltd., vol. 8(1), pages 25-39, February.
    3. Wachira, Catherine & Ruger, Jennifer Prah, 2011. "National poverty reduction strategies and HIV/AIDS governance in Malawi: A preliminary study of shared health governance," Social Science & Medicine, Elsevier, vol. 72(12), pages 1956-1964, June.

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