Inequalities in health, inequalities in health care: four generations of discussion about justice and cost-effectiveness analysis

Kennedy Inst Ethics J. 2000 Jun;10(2):109-27. doi: 10.1353/ken.2000.0014.


The focus of questions of justice in health policy has shifted during the last 20 years, beginning with questions about rights to health care, and then, by the late 1980s, turning to issues of rationing. More recently, attention has focused on alternatives to cost-effectiveness analysis. In addition, health inequalities, and not just inequalities in access to health care, have become the subject of moral analysis. This article examines how such trends have transformed the philosophical landscape and encouraged some in bioethics to seek guidance on normative questions from outside of the contours of traditional philosophical arguments about justice.

MeSH terms

  • Cost-Benefit Analysis*
  • Decision Making
  • Delivery of Health Care*
  • Democracy
  • Economics
  • Empirical Research
  • Ethical Analysis*
  • Ethical Theory
  • Ethics*
  • Freedom
  • Health
  • Health Care Rationing*
  • Health Services Accessibility
  • Human Rights
  • Humans
  • Methods
  • Moral Obligations
  • Public Policy*
  • Quality-Adjusted Life Years
  • Research
  • Resource Allocation*
  • Social Justice*
  • Social Responsibility
  • Social Values
  • Socioeconomic Factors
  • Vulnerable Populations