2007 年 25 巻 p. 81-90
Under the banner of "structural reform without sanctuaries", the government is attempting to promote the introduction of market principles into the medical care system. Although the primary purpose of this reform is to reduce the total national medical expenses, it is also expected that the market mechanism will contribute to the improvement of medical services. However, if we consider the managed care system in America, it is clearly evident that the deregulation of the medical care system produces numerous adverse effects and that the market mechanism does not work as expected. From an ethical point of view, the most serious problem is that excessive deregulation leads to the corruption of medical quality and "social exclusion" of the vulnerable; this is because market principles, by definition, do not include any ethical norms in the regulation of the market itself. Considering the supposed nature of the medical care system, we should control the power of market principles. The national medical care system must be considered as a public issue, and not as a matter of "self-interest"; therefore, it requires the higher principle of "fairness" as its moral foundation.