The purpose of this paper is to discuss one of the most common ethical predicaments faced by public health practitioners: the distribution of limited resources for health. The question we address is the following: If there are limited resources to provide necessary health care, how can we reasonably establish priorities? We discuss this question using as reference a real-life situation, which was the establishment of priorities in the design of a package of high-cost interventions for Seguro Popular in Mexico, a public insurance scheme that extended social protection in health to over 50 million people between 2003 and 2018. The main conclusion of this paper is that the use of explicit ethical assumptions in the design of public policies contribute to their acceptability and eventual success.

中文翻译：

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道德与公共卫生：墨西哥卫生改革中优先事项的定义

本文的目的是讨论公共卫生从业者面临的最常见的道德困境之一：为健康分配有限的资源。我们要解决的问题如下：如果提供必要医疗保健的资源有限，我们如何合理确定优先事项？我们使用现实生活中的情况作为参考来讨论这个问题，即在为墨西哥的 Seguro Popular 设计一揽子高成本干预措施时确定优先事项，这是一项将健康方面的社会保护扩大到超过 5000 万的公共保险计划2003 年至 2018 年之间的人。本文的主要结论是，在公共政策设计中使用明确的道德假设有助于它们的可接受性和最终成功。