Justice, equity and equality: iatrogenesis in the US healthcare system

This paper addresses the current accounting structure in the US healthcare system. It argues that a clear definition of equity (vertical vs. horizontal) must be understood and how this understanding can be used to help achieve a proper allocation of scarce resources within that system. Then using the framework posited in Rawls' Theory of Justice, an ideal type of structure can be created. It further discusses the role of accounting and responsibility of accountants in assuring adequate levels of transparency. Using the concept of iatrogenesis and the arguments of Ivan Illich and Vincent Navarro, a metaphorical-based discussion ensues at the three levels of iatrogenesis defined by Illich: clinical, social and cultural. The paper concludes by identifying that for any healthcare system to work properly, one must 'provide the right care to the right patient at the right time', and that accounting and accountants must play a major role in assuring the structure that accomplishes this.