Benchmarks of fairness: A moral framework for assessing equity

The health care systems of most advanced industrialized countries are currently undergoing extensive reforms. In Europe, in addition to economic and political issues, issues of "equity" and "solidarity" are very much on the minds of some health care reformers. Elsewhere in Europe, economics and politics dominate health care reform, and concerns about fairness are either absent 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 concessions. Issues of fairness were either hidden in the many features of the competing proposals and the debates about them, or totally ignored. In both cases, there has been no practical way to gauge how a given change would alter the equity or fairness of existing health care services. This article addresses that void by presenting ten scorable benchmarks of fairness.