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Justice and Morality in the Fair Distribution of Health Care Resources for Aging Society

One of the prevalent topics in modern medicine is the moral significance of health care in connection with the notion of eqaul access to health care resources available. The range of opportunities utilized by the members of society is considerably affected by the individuals’ health and well-being. That is why the contemporary discourse of ‘equity’ in health care often leads to debates over the ethical issues and ramifications of rationing health services against particular criteria and categorizing different groups of beneficiaries around the criteria. The daunting task of defining and achieving ‘the equity in access to health care’ stemmed from historically incomparable advancement of modern medical science coupled with increasing health care costs in a rapidly aging society. In his theory of justice, supported by the thought experiments of ‘the veil of ignorance’ and ‘the original position,’ the philosopher John Rawls asserted that states or societies must assure fair access to opportunity for all of their members. This argument, rooted in a social contract model, has been extended to resolve some issues in health care delivery. Equal provision of health care may be a forceful cause toward fulfilling the concept of distributive justice within societies. It follows that the state or society ought to carry out the obligation of serving patient needs and offeriing necessary/essential health care services, rather than just exercising the outcome-based assessment measures, for example, between age groups.

Alongside the implications from Rawls’s theory of social justice, the notion of solidarity gives valuable insights into the moral outlook of health care distribution. Solidarity, in the sociopolitical context, is one of the fundamental principles on which the social welfare system is established. While the context-specific interpretation and practical presentation of solidarity varies throughout history, the underpinning ideas of communal cohesion and reciprocal commitment have survived the variations. A sense of mutual obligation encourages the members of soceity to approach the topic of justice in health care distribution from a moral point of view, thus facilitating affective bonds among its members and a willingness to assist others in need. This approach brings forth clues to the question of how to put into practice social justice and morality through the fair distribution of health care resources in an aging society – provision of health care services responsive to patient needs, and the institutionalization of the idea of reciprocity in health care practice and cost sharing. As well, a misleading conceptualization of the elderly population in the context of health care allocation can be reestablished, which merely zooms in on the competing relationship between young and old over limited health care resources. It is resasonable to single out older people on the assumption that they have already consumed major opportunities of their lives and therefore do not deserve priority? Rather, the solidarity between young and old, the morality of aspiration, and integrational compassion should be integrated into a perceptual framework of analysis. Filial piety, as observed in some East Asian countries including Korea, remains a fundamental value among its members and regulates children’s interactions with their parents and older people in general. This Confucian virtue of filial piety still plays a key role in shaping the relational dynamics between age groups and affects the identity of seniors so that it can be reflected in the process of health acre policy-making.

An attempt to incorporate socio-cultural values into health care decisions can bridge some gaps in the argument of fair distribution of health care resources; yet, a few legitimate questions still await answers. First, how can we identify necessary/essential medical treatment options and serve the patients in need without furthering conflict between age groups? Second, how can we alleviate an enormous strain on medical expenditure caused by constrained resources and costly medical innovations? A fair assessment process should be performed on the eqaul opportunities rule, with the load of relevance condition and accountability for reasonableness imposed on decision makers. Opportune governmentla interventions will concurrently play a part in regulating a market-oriented health care system in the manner that effective prcie controls slacken off long-lasting disparities in health care allotment. While the healthcare insurers – physicians, pharmaceutical companies, medical device companies, and healthcare insurance – are encouraged to take the initiative in advancing medical innovations, societal-level efforts are required to make those innovations readily available to those in need at an affordable rate. At the same time, state and social interventions are called for in regulating free market ideology in health care systems and maintaining equity in access to health care.


Sungmin Park is an attorney at law and a member of Bae, Kim & Lee LLC. He has been dealing with issues over the health care regulations (e.g., issues relating to the Pharmaceutical Affairs Act, including permission for drugs and approval-patent linkage system, and those relating to the National Health Insurance Act, including medical fees, new medical technology evaluation and actions for redemption) and medicine intellectual property practice in South Korea. He graduated from Seoul National Unviersity of Pharmacy (2006) and Seoul National University Law School (2012). And he is in the PhD course of Seoul National University Law School majoring in private health insurance in relation to National Health Insurance in South Korea. He authored the sections of Intellectual Property Right Policy, Regulatory Policy, Distribution Management Policy and Industrial Support Policy of Understanding of Pharmaceutical Industry Policies published in 2014 by the Korean Health Industry Development Institute and Ministry of Health and Welfare. He also presented some papers on regulation or patent issues regarding pharmaceuticals.