The meaning of 'justice' in health care

Health care is a scarce good. How should it be distributed? What is--in other words--the meaning of '(distributive) justice' in the context of health care? History of thought handed down two very different notions of justice: to each according to merit v. to each according to need. Although both reflect intuitive notions of general consciousness, ultimately they are diametrically opposed. Analysis of human rights law reveals a unique and rather uncompromising notion of justice in the 'sphere' of health care. Just distribution of health care is distribution according to (objective) need. Market forces are currently being introduced in the Dutch social health care system. Upon reflection, however, it becomes clear that the reforms amount to the introduction of the merit criterion. In the political debates leading up to the reform program financial considerations dominated. Unfortunately, the more fundamental issue was never addressed. The appropriateness of merit as a criterion of distribution in the context of health care was never really considered.