Publication: La justificación de las políticas de salud pública desde la ética y la eficiencia económica: informe SESPAS 2010
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2010-09-14
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Elsevier
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Abstract
Objetivos: En España, en tiempos recientes, algunas voces han puesto en cuestión ciertas políticas de salud pública por posibles invasiones de la libertad personal. El objetivo del capítulo es responder a dichas voces con argumentos éticos y económicos que justifican tales políticas.
Métodos: El presente trabajo plantea la corriente de opinión y sus características. Después, partiendo de Stuart Mill, expone los principios éticos de no maleficencia, beneficencia, autonomía personal y justicia, y algunos conceptos correlativos pertenecientes al plano de la eficiencia económica: efectos externos, monopolio, información incompleta y asimétrica, relación de agencia, bienes públicos y selección adversa.
También se hace somera mención a la justicia o la equidad en economía, y al Estado del bien estar y los sistemas sanitarios públicos. Se discute también la justificación y los límites de las actuaciones “paternalistas” por parte del Estado.
Conclusión: El respeto a la libertad individual no sólo no se opone, si no que exige, la adopción de medidas de salud pública. Si esas actuaciones cumplen ciertos requisitos, no sólo no limitan sino que protegen y amplían la libertad individual.
Objectives: In recent times, various voices in Spain have questioned public health policies as an assault to personal freedom. The present article aims to respond to these voices with ethical and economic arguments. Methods: The scope and characteristics of this current of opinion are described. Then, starting with John Stuart Mill, the ethical principles of non-maleficence, beneficence, personal autonomy and justice, as well as related concepts taken from economic efficiency, such as externalities, monopoly, incomplete and asymmetric information, agency relationship, public goods and adverse selection, are discussed.A short mention is made of equity in economics, the welfare state and public health systems. The justification for paternalist actions by the state, as well as limits to these actions, are briefly discussed. Conclusion: Respect for individual freedom does not exclude the implementation of public health actions but rather demands the adoption of such policies. If these actions comply with certain conditions, they do not limit individual freedom but rather serve to protect it.
Objectives: In recent times, various voices in Spain have questioned public health policies as an assault to personal freedom. The present article aims to respond to these voices with ethical and economic arguments. Methods: The scope and characteristics of this current of opinion are described. Then, starting with John Stuart Mill, the ethical principles of non-maleficence, beneficence, personal autonomy and justice, as well as related concepts taken from economic efficiency, such as externalities, monopoly, incomplete and asymmetric information, agency relationship, public goods and adverse selection, are discussed.A short mention is made of equity in economics, the welfare state and public health systems. The justification for paternalist actions by the state, as well as limits to these actions, are briefly discussed. Conclusion: Respect for individual freedom does not exclude the implementation of public health actions but rather demands the adoption of such policies. If these actions comply with certain conditions, they do not limit individual freedom but rather serve to protect it.
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Salud pública, Ética, Eficiencia económica, Paternalismo, Public health, Ethics, Economic efficiency, Paternalism
Bibliographic citation
Gaceta Sanitaria, 2010, vol. 24, suplemento 1, p. 120-127