보건의료자원의 거시적 배분과 민주주의적 정당성

Almost all countries in the world experience a scarcity of health care resources and the need to ration health care services. Each medical system is faced with difficult decisions concerning treatment coverage and priorities. Current methods of allocation are based on (1) substantial principles of justice, (2) cost-effectiveness analysis, (3) cost-value analysis, and (4) market mechanisms. Given these methods of allocating health care services, the question of legitimacy is rightfully raised. The question of legitimacy needs to be approached in an orderly manner. In the first place, the concept of democratic legitimacy needs to be articulated. Secondly, current methods of allocation must be evaluated. Thirdly, a legitimate method of allocation is needed. This article concentrates on the first and the second step. I argue that current methods of allocation fail to satisfy a democratic conception of legitimacy. However, this conclusion does not mean that these methods of allocating should be totally rejected. Each of these methods has an important element that at least contributes to democratic legitimacy. Based upon the evaluation provided in this article, I introduce a very promising method of allocating health care services, one developed by N. Daniels and J. Sabin.