Exploring Different Interpretations of the Capability Approach in a Health Care Context: Where Next?

Abstract

In comparing the first applications of the capability approach (CA) to health and health care by Ruger with three subsequent interpretations of the CA, this paper identifies two distinct motivations: (i) the adoption of capability as an alternative to utilitarian health maximization, in the context of resource allocation and (ii) facilitating agreement on a core concept of health (incorporating mortality, morbidity and health agency) with which to drive policy reform. Where there is already comprehensive healthcare coverage, research is evolving to consider the broader impact of health on well-being and facilitate the joint evaluation of health and social care services. Although measures developed within this “expansionist” framework are becoming increasingly well used, their inclusion of health itself requires greater consideration. The health capability paradigm adopts health capability as a holistic object of health policy broadly conceived. Whilst instruments exist for assessing health functioning, qualitative studies are beginning to illuminate which indicators should be used to assess health agency. Shortfall sufficiency, a current pillar of the health capability paradigm, is considered as a potentially useful decision-rule when allocating health and social care resources. Setting a shortfall threshold will represent a value judgement and this should be informed through public deliberation and debate. The implications of adopting shortfall sufficiency also need to be explored and alternatives considered.