Rational self-interest and the inverse care law: how Rawls and Nozick might have reflected on Julian Tudor Hart’s problem

The British journal of general practice: the journal of the Royal College of General Practitioners

article

Ayu Takayanagi¹ 

[1]DePauw University,University of Oxford

DOI  :  10.3399/bjgp23X732213

学科分类：卫生学

来源: Royal College of General Practitioners

【 摘 要 】

THE INVERSE CARE LAW The NHS was introduced in Britain in 1948 to provide equal access to health care to everyone in the UK. It has offered ‘ a comprehensive national service, available to all, free at the time of use, non-contributory, and financed from taxation.’ 1 However, Julian Tudor Hart (1927–2018), who was a GP working in Wales, observed that the healthcare availability and the population that needs it have an inverse correlation relationship.1 As factors that contribute to the inverse care law, Tudor Hart suggested that market forces working on primary-care services led to an inequality of health care between the wealthy and the poor.1Tudor Hart argued that the inverse care law is expressed in the lack of availability of healthcare services. Wyszewianski and McLaughlin define availability as, ‘The extent to which the provider has the requisite resources, such as personnel and technology, to meet the needs of the client’.2According to Tudor Hart, doctors didn’t prefer to work in poorer or more working- class areas unless they had social and familial ties.1 People living in such areas at the time, such as miners, tended to work in dangerous and dirty environments and end up with major diseases. Doctors in such areas were supposed to care for patients with less money (funding) even though doctors in more affluent areas could earn more money looking after patients who were less sick and fewer in number. Tudor Hart further observed that the working environment of doctors in deprived areas was poor, but doctors in middle-class areas enjoyed better equipment and resources.1Availability of health care is meaningless unless people can access it. Wyszewianski and McLaughlin define accessibility as, ‘how easily the client can physically reach the provider’s location’.2 Tudor Hart found there were expanding list sizes for GPs in industrial areas. These large list sizes could mean that patients did not receive good quality care or would have to wait longer before being tended to.1In recent times, however, other factors could limit access to health care such as language barriers, the inability to take time off work, stigma associated with illness, and a struggle to get an appointment with a GP.Tudor Hart asserted that ‘the function of the state is, in general, to do those things which the individual cannot do and to assist him to do things better’.1 As the NHS is a state intervention in communion with a market economy I reference here two moral, legal, and political philosophers from a quintessential market economy (the US): John Rawls (1921–2002) and Robert Nozick (1938–2002). Rawls would argue that the state ought to provide need-based support for the population because we have a rational interest in a government that protects us from misfortune, and therefore gives aid to those worst off. In contrast, Nozick would claim that the state should not provide further support (beyond a minimum level) because the government should only provide limited protections to protect people’s natural rights, essentially limited to property and security rights. Taking money away from people to help those in need is therefore an unacceptable affront to liberty.

【 授权许可】

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