Welfarism versus 'free enterprise': considerations of power and justice in the Philippine healthcare system.

The just distribution of benefits and burdens of healthcare, at least in the contemporary Philippine context, is an issue that gravitates towards two opposing doctrines of welfarism and 'free enterprise.' Supported largely by popular opinion, welfarism maintains that social welfare and healthcare are primarily the responsibility of the government. Free enterprise (FE) doctrine, on the other hand, maintains that social welfare is basically a market function and that healthcare should be a private industry that operates under competitive conditions with minimal government control. I will examine the ethical implications of these two doctrines as they inform healthcare programmes by business and government, namely: (a) the Devolution of Health Services and (b) the Philippine Health Maintenance Organization (HMO). I will argue that these doctrines and the health programmes they inform are deficient in following respects: (1) equitable access to healthcare, (2) individual needs for premium healthcare, (3) optimal utilisation of health resources, and (4) the equitable assignment of burdens that healthcare entails. These respects, as considerations of justice, are consistent with an operational definition of 'power' proposed here as 'access to and control of resources.'