Rethinking equal access: Agency, quality, and norms

Abstract

In 2005 the Global Health Council convened healthcare providers, community organizers, policymakers and researchers at Health Systems: Putting Pieces Together to discuss health from a systems perspective. Its report and others have established healthcare access and quality as two of the most important issues in health policy today. Still, there is little agreement about what equal access and quality mean for health system development. At the philosophical level, few have sought to understand why differences in healthcare quality are morally so troubling. While there has been considerable work in medical ethics on equal access, these efforts have neglected health agency (individuals' ability to work toward health goals they value) and health norms, both of which influence individuals' ability to be healthy. This paper argues for rethinking equal access in terms of an alternative ethical aim: to ensure the social conditions in which all individuals have the capability to be healthy. This perspective requires that we examine injustices not just by the level of healthcare resources, but by the: (1) quality of those resources and their capacity to enable effective health functioning; (2) extent to which society supports health agency so that individuals can convert healthcare resources into health functioning; and (3) nature of health norms, which affect individuals' efforts to achieve functioning.

Health Capability: Conceptualization and Operationalization

“…In the health domain, this concept is here called “health agency.”1 The value of freedoms lies in the functionings they permit, so freedoms have worth when they yield valuable health functionings. Broader agency will, of course, influence health agency; one’s educational agency, for example, will affect one’s health agency, because better-educated individuals may negotiate the external environment more effectively to achieve health.…”

One and done? Equality of opportunity and repeated access to scarce, indivisible medical resources

“…Finally, I acknowledge that even successfully resolving this particular equality of access question does not necessarily address the potential for differences in quality and in health agency to still systematically impact different patients’ ability to achieve healthy functioning [67]. In the present context, it is possible that patients with prior use of medical resources have a systematically enhanced ability to interface with the care delivery system (i.e.…”

Promoción de los derechos en salud en Perú: una aproximación desde la perspectiva de acción de la Superintendencia Nacional de Salud

“…Todo ello considera también que el disfrute pleno de la salud, depende del compromiso y voluntad de cada individuo y del cuerpo social, por lo que la accesibilidad, disponibilidad, aceptabilidad y calidad de los servicios de salud será efectivo en tanto se aseguren procesos de desarrollo de capacidades del Estado como garante de derechos y del ciudadano como titular de los mismos (25)(26)(27) .…”