Justice and health for all.

The ethical aspects of the distribution of resources for health care at the macro level deserve more study than they hitherto received. The socio-medical and economic policy implications of four distribution principles are reviewed: the utilitarian, the egalitarian, the equal access and the libertarian. Policy in welfare states is primarily based on the equal access principle. Economic factors have led to policy proposals in libertarian and utilitarian directions; competition, cost-sharing, cost-effectiveness and individual responsibility are central to the discussion. The authors conclude that it remains to be seen whether these alternatives produce the results expected. They recommend more comprehensive examination of the practical and political feasibilities of a more egalitarian policy.