Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA.
Health Aff (Millwood). 2009 Sep-Oct;28(5):w909-16. doi: 10.1377/hlthaff.28.5.w909. Epub 2009 Aug 18.
Three key ethical issues should inform the broader debate about health reform: (1) Why pursue universal coverage? (2) Why is cost containment an ethical issue? (3) What is fairness in financing? After examining these issues, we conclude that the core ethical values underlying each of these goals-including expanding opportunity, sharing burdens equally, and respect for persons-limit the means that can be pursued in health reform. Although national health reform will not accomplish all of the objectives of social justice, true comprehensive reform-even under conditions of political compromise-represents an important step forward.
（1）为什么要追求全民覆盖？（2）为什么控制成本是一个伦理问题？（3）筹资公平的含义是什么？在研究了这些问题之后，我们得出结论，这些目标所依据的核心伦理价值观，包括扩大机会、平等分担负担和尊重个人，限制了医改可以采取的手段。虽然国家医改不会实现社会公正的所有目标，但真正的全面改革——即使在政治妥协的条件下——也代表着向前迈出的重要一步。
