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

Document Type : Debate


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


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.


Main Subjects

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  • Receive Date: 11 August 2017
  • Revise Date: 27 September 2017
  • Accept Date: 02 October 2017
  • First Publish Date: 01 April 2018