title: [Shared governance and reasonableness as ethical contributions to health policy].
abstract: Health is one of the fundamental human rights. Recognizing it as a right means that the State has an obligation to ensure a minimum level of opportunities is maintained, and to restore it when lost. This minimum level may not be covered in periods of economic crisis, such as the one we are currently experiencing.Managed care, focused on economic questions, emerged after the crisis of 1973 in order to help make clinical decisions based on economic factors. In practice, the result of managed care was to turn economic cost control into an end in itself while forgetting about equity; something for which it has been challenged from an ethical perspective. Since then, many authors have attempted to reconcile efficiency and equity in health management, but the debate remains open.In this article, and basing our approach on the theories of P. Ruger and Norman Daniels, we argue that shared health governance and accountability for reasonableness can offer significant ethical contributions in the process of achieving an efficient and fair health system. In the model we propose, citizens, professionals and health institutions all play an active role in capacity building in the field of health. These capacities are related to healthy lifestyles, accessible and transparent information, the promotion of self-care, the acquisition of knowledge, skills and appropriate attitudes, leadership based on values and co-responsibility to achieve set goals in a reasonable way. If we develop these capacities, we will have used the current economic crisis as an opportunity for improving ethical practice in the field of health.
authors.affiliation: Grupo de Investigación en Bioética, Universitat de València, València, España. ana.maria.costa@uv.es
authors.forename: Ana M
authors.initials: AM
authors.lastname: Costa-Alcaraz
authors.forename: Fernando
authors.initials: F
authors.lastname: Calvo-Rigual
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Siurana-Aparisi
mesh_terms: D026688:Bioethical Issues; D054976:Clinical Governance / Q000941:ethics*; D003363:Cost Control / Q000941:ethics; D004526:Efficiency; D019981:Health Care Sector / Q000941:ethics; D006291:Health Policy; D054625:Healthcare Disparities / Q000941:ethics; D006801:Humans; D008329:Managed Care Programs / Q000191:economics / Q000941:ethics*