Distributing Health

Abstract

All healthcare systems must prioritize and evaluate distributive options. This book provides an overview of and introduction to the most prominent procedural and substantive normative approaches to how health outcomes and health distribution options should be evaluated. It also develops and presents an original hybrid approach that relies on both substantive and procedural considerations. The hybrid approach suggests that we should be pluralists when it comes to substantive questions about what is valuable and accept three different substantive principles: health maximization, lifetime equality, and time-slice sufficiency. When one accepts pluralism, questions about whether all-things-considered comparisons of options always determinately rank all options arise. On the suggested hybrid approach, there are significant comparability problems, and the principles sometimes fail to determinately rank all options. As a complement to the substantive principles, the hybrid approach suggests that one should invoke an evaluative criterion of the second order that reflects the collective will of the affected people. Such a criterion can rank options that cannot be ranked by the substantive principles and increases the legitimacy of the evaluation.