自由與平等的張力與中和: 醫療體制的跨文化比較研究

The design and implementation of healthcare systems inevitably involve a normative tension between the values of liberty and equality. Different countries and regions, influenced by their social values, economic structures, and policy priorities, make distinct trade-offs between these two principles, resulting in diverse institutional arrangements. This article conducts a cross-cultural comparative analysis of three representative healthcare systems—those of the United States, Canada, and Hong Kong—by examining their ethical foundations, delivery arrangements, financing models, and operational outcomes. The libertarianoriented U.S. model prioritizes individual choice and market-driven innovation, yet it is plagued by severe inequalities and staggering costs. Conversely, the egalitarian Canadian model, which emphasizes universality through state-led provision, achieves greater equality at the potential expensed of individual liberty and often faces challenge of resource constraints. Hong Kong’s two-tier model, by contrast, represents a pragmatic synthesis, seeking to balance these competing values through a complementary integration of public and private services. This hybrid model not only fosters flexibility and efficiency but also demonstrates enhanced financial sustainability. Grounding our analysis in Confucian virtue ethics, particularly the ideal of zhonghe (harmonious balance), we content that such a culturally embedded paradigm offers both ethical justification and policy relevance for reconciling the liberty-equality dichotomy in healthcare reform. Hong Kong’s experience illustrates how culturally informed ethical frameworks can guide institutional innovation, providing valuable insights for global efforts to navigate complex value trade-offs and pursue healthcare reform amid growing demographic and fiscal pressures.