The No-Destination Ship of Priority-Setting in Healthcare: A Call for More Democracy

Document Type: Debate

Author

School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada

Abstract

In dealing with scarcity of resources within healthcare systems, decision-makers inevitably have to make choices about which services to fund. Setting priorities represents a challenging task that requires systematic, explicit and transparent methodologies with focus on economic efficiency. In addition, the engagement of the general public in the process of decision-making has been regarded as one of the most important aspects of the management of publicly-funded health systems in liberal democracies. In the current essay, we aim to discuss the problematics of public engagement in the process of resource allocation and priority-setting within the context of publiclyfunded health systems. Our central argument is that although there may be a conflict between democratic mechanisms of citizen participation and economic efficiency, in the extra-welfarist sense, expected for/from the system, the solution for this tension does not seem to rely on more or novel authoritative technocratic approaches, but rather on the deepening and betterment of democratic participation.

Keywords

Main Subjects


  1. Galeano E. Walking Words. Reprint ed. New York, NY: WW Norton & Company; 1997:328.
  2. Mitton C, Donaldson C. Priority Setting Toolkit: Guide to the Use of Economics in Healthcare Decision Making. London, GB: John Wiley & Sons, Incorporated; 2009.
  3. The Fraser Institute. The Sustainability of Health Care Spending in Canada. https://www.fraserinstitute.org/studies/sustainability-of-health-care-spending-in-canada. Published May 31, 2016.
  4. Seixas BV. Welfarism and extra-welfarism: a critical overview. Cad Saude Publica. 2017;33(8):e00014317. doi:10.1590/0102-311x00014317
  5. Wolff J. An Introduction to Political Philosophy. Oxford: Oxford University Press; 1996:237.
  6. Bobbio N. The Future of Democracy: A Defence of the Rules of the Game. University of Minnesota Press; 1987:184.
  7. Mitton C, Donaldson C. Resource allocation in health care: health economics and beyond. Health Care Anal. 2003;11(3):245-257. doi:10.1023/B:HCAN.0000005496.74131.a0
  8. Rice T. The Economics of Health Revisited. Chicago: Health Administration Press; 1998.
  9. Sen A. Inequality Reexamined. New York: Russell Sage Foundation; 1992:207.
  10. Kahneman D. Thinking, Fast and Slow. Toronto: Doubleday Canada; 2011:499.
  11. Langworth R. Churchill by Himself: The Definitive Collection of Quotations. 1st ed. New York: PublicAffairs; 2008:627.
  12. Mitton C, Smith N, Peacock S, Evoy B, Abelson J. Public participation in health care priority setting: A scoping review. Health Policy. 2009;91(3):219-228. doi:10.1016/j.healthpol.2009.01.005
  13. Regier DA, Bentley C, Mitton C, et al. Public engagement in priority-setting: results from a pan-Canadian survey of decision-makers in cancer control. Soc Sci Med. 2014;122:130-139. doi:10.1016/j.socscimed.2014.10.038
  14. Rosenberg A. Philosophy of Science: A Contemporary Introduction. 3rd ed. New York: Routledge; 2011:320.
  15. Bickford S. The Dissonance of Democracy: Listening, Conflict, and Citizenship. Cornell University Press; 1996:228.