“Communitarian claims” as an ethical basis for allocating health care resources

Abstract

This paper presents the case for re-examining the most commonly adopted basis of resource allocation in health care, i.e. need. The key problems identified with most needs approaches are (a) defining its precise meaning, (b) that the community is seldom consulted as to first what constitute needs for health care or second what relative weights are to be attached to health gains aimed at addressing different needs and (c) more generally, proceeding without knowing what the community wants the objectives of health care to be. It is suggested that John Broome's notion of “claims”, especially what this paper calls “communitarian claims”, may be helpful in providing a better basis for allocating health care resources. Such “communitarian claims” allow inter alia for the community to be involved in setting the social choice rules with respect to the governance of health care and for determining what it is that it (the community) wants from its health service. The links to rights are also identified and the advantages of communitarian claims over both a simple concept of need and rights are set out, without arguing that either needs (or rights) ought necessarily to be abandoned as bases for resource allocation in health care.