What is the Preferable Idea of Justice in Healthcare?

We are experiencing a period of severe economic crisis, in some ways worse than that of 1929. One of the most affected areas is the health field. In this paper, I propose a comparison between Italian ad American healthcare model, to analyze and reflect on the concept of justice that is underlying and which can be redefined, under certain conditions. The most popular definition of principle of Justice in bioethical context is, for example, the definition proposed by H.T. Engelhardt jr., who considers fair every clinical practice realized implementing health policies that guarantee equal access to health care. Going beyond traditional theories and ‘classic’ definitions, justice has been redefined by other authors, such as Amartya Sen, as the principle that considers ethically justified every clinical practice, which is realized by implementing an healthcare policy that guarantees individuals’ equal access to resources, whereas the evaluation of what is worth doing, being, or using contributes to determine equity itself. Another important aspect that needs to be taken into consideration concerns the analysis of different models of healthcare systems in light of the respective qualification of ‘health’. The substantial ethical-legal difference that characterizes ‘health’ is reflected on the concrete procedures of goods and services distribution, especially on the different healthcare models, that will be subject of bioethical analysis in this paper. The fundamental question is about which is the fair health care to be requested by citizens and to be provided by governments. This question is strictly linked to another issue: which is the preferable idea of justice in healthcare amongst those available in the current debate