For most of us, health care is a significant part of our lives. It helps to preserve and restore our bodies, it allows us to perform the work that we do, and it provides comfort and security in times of illness and death. In addition, the use of health care reflects many other values and aspirations: a belief in an ultimate good, the importance of the family, the desire to be seen as morally decent, and, above all, the desire to enjoy life to the fullest possible extent.
Unlike other consumer goods, which are often readily available in the marketplace, health care is a scarce resource. There is a limit to the number of primary care physicians, hospitals and advanced technology that can be built and supplied at a given cost, as well as a limit on the amount of money that people can spend on healthcare in any one year. Furthermore, some individuals do not have access to any form of health care because they cannot afford it. These barriers are sometimes caused by geographic limitations — for example, in rural areas or inner cities — and, more frequently, by financial limitations — such as insufficient insurance coverage or the inability to meet the required co-payments.
Because of these limitations, a complex system of health care financing and delivery has evolved. It includes private insurance companies, which are owned and operated by shareholders; employer-sponsored plans that provide a variety of health care options for employees and their families; government-financed programs, such as Medicare and Medicaid; and numerous non-profit health foundations and other groups that provide services for the poor and needy. The emergence of these systems has resulted in an explosion of medical knowledge and technological advancements. However, they have also created serious problems of access, quality and cost.
Various theories of health care exist to explain these problems and guide policymakers as they seek solutions. Some are based on the ideas of economists who apply market principles to the provision of health care services. These ideas assume that consumers and providers will act in ways that will maximize the utility of health care resources, while at the same time minimizing costs. This theory is sometimes called the “efficiency approach.”
Another school of thought, associated with the philosophy of libertarianism, believes that the role of government should be limited to a few key functions, such as maintaining law and order. Libertarians believe that individual patients should be allowed to purchase whatever insurance and health care services they want, and that the free market will efficiently supply what is needed.
Other theorists argue that the unique nature of healthcare requires a more nuanced and sophisticated analysis than simple market economics can offer. These ideas include the notions of “people-centred” and “empathy-based” care, which involve a physician’s obligation to treat each patient as an individual. These philosophies require the physician to be aware of his or her own values and beliefs as they relate to the patient’s, as well as the cultural, social and ethical context in which the health care relationship is taking place.