Benchmarks of fairness: A moral framework for assessing equity

The health care systems of most advanced industrialized countries are curre ntly undergoing extensive reforms. In Europe, in addition to economic and p olitical issues, issues of "equity" and "solidarity" are very much on the m inds of some health care reformers. Elsewhere in Europe, economics and poli tics dominate health care reform, and concerns about fairness are either ab sent or of secondary importance. Similarly, the recent health care debates in the United States were largely carried out in terms of payment schemes, cost-containment and outcome measures, campaign strategies, and political c oncessions. Issues of fairness were either hidden in the many features of t he competing proposals and the debates about them, or totally ignored. In b oth cases, there has been no practical way to gauge how a given change woul d alter the equity or fairness of existing health care services. This artic le addresses that void by presenting ten scorable benchmarks of fairness.