A morally justifiable health care system should not only ensure that everyone has equal access to basic health care services, but also be financially sustainable. It is normally supposed that governments, individuals and families take joint responsibility for health care in a certain country or region. Their levels of financial responsibility are a significant factor in the effective allocation of healthcare resources and fair delivery of health care services.
This paper divides the historical evolution of health care financing responsibilities in urban China since 1949 into four periods: a planned economy period, an economic system transition period, an initial period of market economy and a universal health coverage period. Based on Confucian ethical principles, the author reflects on financing responsibilities in urban China. She determines that the financing responsibilities of different periods have changed from government- to individual-dominant, finally achieving a balance between government, the market and the individual. The author argues that from a moral standpoint, according to Confucian ethical appeals on health justice, a benevolent government should practice neither the doctrine of absolute equalization nor the principle of individual liberalism. As the idea that the family comprises the primary community is still active in contemporary China, family responsibility should be emphasized along with health care financing policy. According to Confucianism, a morally just health care financing responsibility requires a proper balance and harmony between individuals, families and governments.