Indeterminacy and the principle of need

Anders Herlitz

doi:10.1007/s11017-016-9393-5

Abstract

The principle of need—the idea that resources should be allocated according to need—is often invoked in priority setting in the health care sector. In this article, I argue that a reasonable principle of need must be indeterminate, and examine three different ways that this can be dealt with: appendicizing the principle with further principles, imposing determinacy, or empowering decision makers. I argue that need must be conceptualized as a composite property composed of at least two factors: health shortfall and capacity to benefit. When one examines how the different factors relate to each other, one discovers that this is sometimes indeterminate. I illustrate this indeterminacy in this article by applying the small improvement argument. If the relation between the factors are always determinate, the comparative relation changes by a small adjustment. Yet, if two needs are dissimilar but of seemingly equal magnitude, the comparative relation does not change by a small adjustment of one of the factors. I then outline arguments in favor of each of the three strategies for dealing with indeterminacy, but also point out that all strategies have significant shortcomings. More research is needed concerning how to deal with this indeterminacy, and the most promising path seems to be to scrutinize the position of the principle of need among a plurality of relevant principles for priority setting in the health care sector.

Highlights

The principle of need is often proposed as a decision guide for priority setting in the health care sector
This article contributes to the debate on the nature and usability of a principle of need for priority setting by pointing toward some innate complications with reasonable principles of need that can be used to establish prioritization issues and toward the different ways in which these can be dealt with
A reasonable suggestion is, to conceptualize health need for the purpose of priority setting and for the purpose of developing a reasonable principle of need that can be applied in prioritization decisions as a composite property made up of two factors: Health need 1⁄4 f ðhealth shortfall; capacity to benefitÞ

Summary

Introduction

The principle of need is often proposed as a decision guide for priority setting in the health care sector. A reasonable suggestion is, to conceptualize health need for the purpose of priority setting and for the purpose of developing a reasonable principle of need that can be applied in prioritization decisions as a composite property made up of two factors: Health need 1⁄4 f ðhealth shortfall; capacity to benefitÞ

Results

Conclusion