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

Brayan V Seixas

doi:10.15171/ijhpm.2017.119

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.

Highlights

In dealing with scarcity of resources in the healthcare system, decision-makers inevitably have to make choices about which services to fund
We aim to discuss the problematics of engaging the public in the process of resource allocation and priority-setting within the context of publicly-funded healthcare systems, with a particular focus on the widest levels of governance
Our central argument is that there may be a conflict between democratic mechanisms of citizen participation and economic efficiency 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

Summary

Introduction

In dealing with scarcity of resources in the healthcare system, decision-makers inevitably have to make choices about which services to fund (and, which services not to fund). Each of these methods relies on different ethical, economic and managerial principles to deal with the problem of decision-making in priority-setting and they contemplate the issue of public engagement in different manners.

Objectives

Results

Conclusion