Many societies, and nearly all wealthy, developed countries, provide universal access to a broad range of public health and personal medical services. Is such access to health care a requirement of social justice, or is it simply a matter of social policy that some countries adopt and others do not? If it is a requirement of social justice, we should be clear about what kinds of care we owe people and how we determine what care is owed if we cannot (...) possibly meet every health need, as arguably no society can. We should be clear about what constitutes appropriate access to that care, given that there are diverse barriers to access. We must also be able to say why we owe these things as a matter of justice, and, of course, different accounts of social justice will bake and serve this cake in different ways. (shrink)

This chapter concerns the normativity of the concepts of paternalism and libertarian paternalism. The first concept is central in evaluating public health policy, but its meaning is controversial. The second concept is equally controversial and has received much attention recently. It may or may not shape the future evaluation of public health policy. In order to facilitate honest and fruitful debate, I consider three approaches to these concepts, in terms of their normativity. Concepts, I claim, may be considered nonnormative, normatively (...) charged, or normative in that they involve more complex relationships between values or duties. While the last approach is often best, other approaches may be appropriate depending on the context and purpose of discussion. The chapter’s conceptual investigation is illustrated by application to two public health policies: a tax on the consumption of fat and the encouragement of health-promoting food displays in restaurants and supermarkets. (shrink)

State Medicaid programs have proposed closed formularies to limit spending on drugs. Closed formularies can be justified when they enable spending on other socially valuable aims. However, it is still necessary to justify guidelines informing formulary design, which can be done through a process of decision making that includes the public. This article examines criticisms that Medicaid closed formularies limit deliberation about decisions that affect drug access and unfairly disadvantage poor patients. Although unfairness to poor patients is a risk, it (...) is not a problem unique to Medicaid, since private insurance programs have also implemented closed formularies. (shrink)

El contexto de crisis y restricciones presupuestarias sirve de pretexto para promover en la Comunidad de Madrid la implantación de un modelo dual de gestión de los centros y servicios sanitarios, ampliamente contestado en la calle por profesionales sanitarios, asociaciones, pacientes y usuarios. Este proceso se inicia sin evidencia científico-técnica que avale las presuntas ventajas del modelo de concesión y carece de una evaluación solvente de impacto sanitario, conforme a estándares de transparencia, rendición de cuentas y calidad democrática. Entre los (...) aspectos éticos y jurídicos involucrados en este debate analizo los relacionados con el conflicto de intereses y las evidencias recientes que desaconsejan adoptar en España modelos similares. Tras analizar el desafío que supone el nuevo marco institucional para el ejercicio de la responsabilidad profesional conforme a criterios de equidad y buenas prácticas, se concluye aportando elementos para generar un marco más equilibrado de reformas. (shrink)