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In a democracy, what should a healthcare system do? A dilemma for public policymakers

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  • Malcolm Oswald
Abstract
In modern representative democracies, much healthcare is publicly funded or provided and so the question of what healthcare systems should do is a matter of public policy. Given that public resources are inevitably limited, what should be done and who should benefit from healthcare? It is a dilemma for policymakers and a subject of debate within several disciplines, but rarely across disciplines. In this paper, I draw on thinking from several disciplines and especially philosophy, economics, and systems theory. I conclude that economist and philosopher John Broome’s writing provides the framework for an answer: a healthcare system in a democracy should do as much good as possible, although sometimes we should sacrifice some overall good for the sake of fairness. This leaves open some detailed questions about what in practice we consider to be good and fair, and about when some good should be traded off in order to be fair. The answers to these questions depend on our values, or as explained by systems theory, our weltanschauung. How policy decisions should be made when citizens’ values differ is a subject of extensive academic debate. However, it is a separate question. Representative democracies have mechanisms for resolving such debates.

Suggested Citation

  • Malcolm Oswald, 2015. "In a democracy, what should a healthcare system do? A dilemma for public policymakers," Politics, Philosophy & Economics, , vol. 14(1), pages 23-52, February.
    • Handle: RePEc:sae:pophec:v:14:y:2015:i:1:p:23-52
    DOI: 10.1177/1470594X13497670
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    References listed on IDEAS

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    1. Gibson, Jennifer L. & Martin, Douglas K. & Singer, Peter A., 2005. "Priority setting in hospitals: Fairness, inclusiveness, and the problem of institutional power differences," Social Science & Medicine, Elsevier, vol. 61(11), pages 2355-2362, December.
    2. Paul Dolan & Rebecca Shaw & Aki Tsuchiya & Alan Williams, 2005. "QALY maximisation and people's preferences: a methodological review of the literature," Health Economics, John Wiley & Sons, Ltd., vol. 14(2), pages 197-208, February.
    3. Anand, Paul & Dolan, Paul, 2005. "Equity, capabilities and health," Social Science & Medicine, Elsevier, vol. 60(2), pages 219-222, January.
    4. Gruskin, S. & Daniels, N., 2008. "Process is the point - Justice and human rights: Priority setting and fair deliberative process," American Journal of Public Health, American Public Health Association, vol. 98(9), pages 1573-1577.
    5. Richard Cookson, 2005. "QALYs and the capability approach," Health Economics, John Wiley & Sons, Ltd., vol. 14(8), pages 817-829, August.
    6. Cohen-Charash, Yochi & Spector, Paul E., 2001. "The Role of Justice in Organizations: A Meta-Analysis," Organizational Behavior and Human Decision Processes, Elsevier, vol. 86(2), pages 278-321, November.
    7. Amartya Sen, 2002. "Why health equity?," Health Economics, John Wiley & Sons, Ltd., vol. 11(8), pages 659-666, December.
    8. Aki Tsuchiya, 2000. "QALYs and ageism: philosophical theories and age weighting," Health Economics, John Wiley & Sons, Ltd., vol. 9(1), pages 57-68, January.
    9. Broome,John, 1999. "Ethics out of Economics," Cambridge Books, Cambridge University Press, number 9780521644914, September.
    10. Anonymous, 1948. "World Health Organization," International Organization, Cambridge University Press, vol. 2(2), pages 374-377, June.
    11. Amartya Sen, 2005. "Human Rights and Capabilities," Journal of Human Development and Capabilities, Taylor & Francis Journals, vol. 6(2), pages 151-166.
    12. Anonymous, 1948. "World Health Organization," International Organization, Cambridge University Press, vol. 2(1), pages 138-140, February.
    13. Werner B.F. Brouwer & Marc A. Koopmanschap & Frans F.H. Rutten, 1997. "Productivity costs in cost‐effectiveness analysis: numerator or denominator: a further discussion," Health Economics, John Wiley & Sons, Ltd., vol. 6(5), pages 511-514, September.
    14. Joanna Coast & Richard Smith & Paula Lorgelly, 2008. "Should the capability approach be applied in Health Economics?," Health Economics, John Wiley & Sons, Ltd., vol. 17(6), pages 667-670, June.
    15. Anonymous, 1948. "World Health Organization," International Organization, Cambridge University Press, vol. 2(3), pages 540-542, September.
    16. McGuire, Martin C & Aaron, Henry J, 1969. "Efficiency and Equity in the Optimal Supply of a Public Good," The Review of Economics and Statistics, MIT Press, vol. 51(1), pages 31-39, February.
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