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Health and Social Justice$
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Jennifer Prah Ruger

Print publication date: 2009

Print ISBN-13: 9780199559978

Published to Oxford Scholarship Online: February 2010

DOI: 10.1093/acprof:oso/9780199559978.001.0001

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A Health Capability Account of Equal Access

A Health Capability Account of Equal Access

(p.133) 6 A Health Capability Account of Equal Access
Health and Social Justice

Jennifer Prah Ruger (Contributor Webpage)

Oxford University Press

This chapter evaluates health care's impact on individuals' health capability and addresses what equal access, quality and a right to health and health care mean for health system development. Along the political spectrum, access is variously viewed as a negative right (preventing access is wrong), a right to a decent minimum of care, or government‐guaranteed equal access to health. The chapter proposes recasting equal access to ensure social conditions that offer all individuals the capability for health. The health capability paradigm evaluates the justness of health care services by their effectiveness in enhancing health capability and bringing individuals as close to a level of optimal health functioning as circumstances permit. This is gauged by assessing individual health needs, health agency and health norms. The paradigm is needs‐based, requiring that health care be medically necessary and medically appropriate. It also provides justification for high‐quality care, and considers how health norms and risk determine health agency. It critically examines notions of proportionality, and horizontal and vertical equity. Finally, it addresses concerns about responsibility and health and the comparison between voluntary and involuntary risk and offers analysis of the fit between the health capability paradigm and public policies that invoke paternalism and libertarian paternalism.

Keywords:   health capability, health functioning, health needs, decent minimum, health agency, high quality care, equal access, decent minimum, right to health care, responsibility and health, voluntary risk, paternalism, libertarian paternalism, health norms

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