Liberty in Health Care: A Comparative Study Between Hong Kong and Mainland China

Abstract

This essay contends that individual liberty, understood as the permissibility of making choices about one's own health care in support of one's own good and the good of one's family utilizing private resources, is central to the moral foundations of a health care system. Such individual freedoms are important not only because they often support more efficient and effective health care services, but because they permit individuals to fulfill important moral duties. A comparative study of the health care systems in Hong Kong and mainland China is utilized to illustrate the conceptual and moral concerns at stake. Both regions have implemented two-tier health care systems with a public tier of basic health care services together with a second tier of privately purchased health care. As we document, Hong Kong permits patients and doctors significantly greater opportunities to choose private health care of typically higher medical quality than their mainland counterparts. As a result, individuals are able to obtain higher quality health care while also fulfilling important moral duties for themselves and their families. In this sense, Hong Kong's health care system is morally superior to mainland China's. In each case, Confucianism's concerns regarding equality are partly satisfied through the provision of public health care services on the basic tier, while appropriate use of private resources in support of oneself and one's family is permissibly exercised on the private tier. Although it is true that inequalities in health care access and outcome are inevitable within a system that permits such individual freedoms, we argue that such inequalities are morally justifiable in terms of Confucian ethical thought.

Keywords: Confucian ethics; equality; freedom; freedom of choice; justice; liberty; two-tier health care system.