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Need, equality and social justice


  • Tony J Culyer
  • Alan Wagstaff


It is frequently claimed that social justice requires that some goods – medical care is a frequently cited example – be distributed according to “need”. The most common justification for adoption of this principle is the cause of inequality: the principles of “distribution according to need” and “equality” are seen as interrelated. In this paper we propose a definition of need and explore the distributional implications of allocating resources according to need. We dispute the claim that the principles of equality and “distribution according to need” are in any way linked and argue that the latter is unlikely in general to result in the attainment of equality and may actually increase inequality.

Suggested Citation

  • Tony J Culyer & Alan Wagstaff, 1991. "Need, equality and social justice," Working Papers 090chedp, Centre for Health Economics, University of York.
  • Handle: RePEc:chy:respap:90chedp

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    References listed on IDEAS

    1. Wagstaff, Adam, 1991. "QALYs and the equity-efficiency trade-off," Journal of Health Economics, Elsevier, vol. 10(1), pages 21-41, May.
    2. Sen, Amartya K, 1979. "Personal Utilities and Public Judgements: Or What's Wrong with Welfare Economics?," Economic Journal, Royal Economic Society, vol. 89(355), pages 537-558, September.
    3. Culyer, A J, 1989. "The Normative Economics of Health Care Finance and Provision," Oxford Review of Economic Policy, Oxford University Press, vol. 5(1), pages 34-58, Spring.
    4. Le Grand, Julian, 1978. "The Distribution of Public Expenditure: The Case of Health Care," Economica, London School of Economics and Political Science, vol. 45(178), pages 125-142, May.
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    Cited by:

    1. Clark, Derek, 1995. "Priority setting in health care: An axiomatic bargaining approach," Journal of Health Economics, Elsevier, vol. 14(3), pages 345-360, August.
    2. Andrew M Jones, 1995. "A microeconometric analysis of smoking in the UK health and lifestyle survey," Working Papers 139chedp, Centre for Health Economics, University of York.
    3. Olsen, Jan Abel, 1997. "Theories of justice and their implications for priority setting in health care," Journal of Health Economics, Elsevier, vol. 16(6), pages 625-639, December.

    More about this item


    equality; binary; need;


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