Medicare and the Non-Insured Health Benefits and Interim Federal Health Programs: A Procedural Justice Analysis

Michael Da Silva


Procedural justice in health care goods and services allocation is a necessary, though likely insufficient, condition for a just health care system. Specific health care systems should accordingly be subject to procedural justice analyses. Norman Daniels and James E Sabin’s accountability for reasonableness framework is one of the best accounts of procedural justice in the health care allocation context. This framework requires the public display of decisions and the reasons for health care allocation decisions (“publicity” or “transparency”), the use of publicly accepted or acceptable rationales in those decisions (“acceptance” or “acceptability”), and mechanisms for challenging and/or appealing the decisions (“reviewability”); it may also require legal protection of the fulfillment of the first three conditions (“regulation”). These conditions provide clear metrics for assessing nations’ compliance with their framework account of procedural justice. This article accordingly applies that framework to three pillars of the Canadian health care system – Medicare, the Interim Federal Health Program, and the Non-Insured Health Benefits Program – to assess the extent to which Canada meets the demands of at least one influential account of procedural justice. It ultimately finds serious deficits in the publicity/transparency of the Canadian health care system, which makes it difficult to apply acceptability metrics, but identifies some progressive steps in better compliance with the publicity/transparency and reviewability components of the accountability for reasonableness framework. It also identifies non-drastic measures Canada can take to better achieve Daniels and Sabin’s vision of procedural justice in health care allocation.

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