Despite the substantial literature on the financing and benefit incidence of social health insurance, the principles underlying such schemes are little debated. This article examines one of these key principles: to each according to his needs; from each according to his means. The authors discuss both sides of this principle at a conceptual level. On the needs side, they examine the issue of vertical equity. The approach of “communitarian claims” is proposed, both for eliciting the components of need and for determining the relative weights to be attached to the vertical dimensions of equity in health service delivery. On the means side, the authors also look to communitarian claims to assist in determining who should bear what burden in paying for social health insurance. They argue that with respect to the concept of “from each according to his means,” it is useful to incorporate an element of willingness to pay, but meaning here the community's willingness to pay.
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