Better health is of course the raison d’être of a health system, and unquestionably its
primary or defining goal: if health systems did nothing to protect or improve health there
would be no reason for them. Other systems in society may contribute greatly to the population’s
health, but not as their primary goal. For example, the education system makes a
large difference to health, but its defining goal is to educate. Influence also flows the other
way: better health makes children better able to learn, but that is not the defining purpose
of the health system. In contrast, the goal of fair financing is common to all societal systems.
This is obvious when the system is paid for socially, but it holds even when everything
is financed purely by individual purchases. It is only the notion of fairness that may vary.
“Getting what you pay for” is generally accepted as fair in market transactions, but seems
much less fair where health services are concerned. Similarly, in any system, people have
expectations which society regards as legitimate, as to how they should be treated, both
physically and psychologically. Responsiveness is therefore always a social goal. Taking the
education system as an example, fair financing means the right balance of contributions
from households which do and those which do not have children in school, and enough
subsidy that poor children are not denied schooling for financial reasons. Responsiveness
includes respect for parents’ wishes for their children, and avoiding abuse or humiliation of
the students themselves.