Skip to main content

Priority setting in health care: from arbitrariness to societal values


This paper develops an account of the normative basis of priority setting in health care as combining the values which a given society holds for the common good of its members, with the universal provided by a principle of common humanity. We discuss national differences in health basket in Europe and argue that health care decision-making in complex social and moral frameworks is best thought of as anchored in such a principle by drawing on the philosophy of need. We show that health care needs are ethically ‘thick’ needs whose psychological and social construction can best be understood in terms of David Wiggins's notion of vital need: a person's need is vital when failure to meet it leads to their harm and suffering. The moral dimension of priority setting which operates across different societies’ health care systems is located in the demands both of and on any society to avoid harm to its members.

Corresponding author
Hide All
Batifoulier P., Latsis J., and Merchiers J. (2009), ‘The Philosophy of Need and the Normative Foundations of Health Policy’, Revue de Philosophie Économique, 10 (1): 79101.
Brouwer W., Culyer A., van Exel J., and Rutten F. (2008), ‘Welfarism vs Extra-WelfarismJournal of Health Economics, 27: 325338.
Busse R., Schreyogg J., and Smith P. (2008), ‘Variability I, Healthcare Treatment Costs Amongst Nine EU Countries – Results from the Healthbasket Project’, Health Economics, 17: S1S8.
Cookson R. and Dolan P. (2005), ‘Principles of Justice in Health Care Rationing’, Journal of Medical Ethics, 26: 323329.
Culyer A. (1995), ‘Need: The Idea Won't Do – But We Still Need It’, Social Sciences and Medicine, 40 (6): 727730.
Davis J. B. (ed.), (2001), The Social Economics of Health Care, London: Routledge.
Dolan P. and Tsuchiya A. (2005), ‘Health Priorities and Public Preferences: The Relative Importance of Past Health Experience and Future Health Prospects’, Journal of Health Economics, 24: 703714.
Dormont B., Grignon M., and Huber H. (2006), ‘Health Expenditure Growth: Reassessing the Threat of Ageing’, Health Economics, 15: 947963.
Evans R. (1974), ‘Supplier-Induced Demand: Some Empirical Evidence and Implications’, in Perlman M. (ed.), The Economics of Health and Medical Care, London: Macmillan, pp. 162173.
Green C. J. (2009), ‘Investigating Public Preferences on Severity of Health as a Relevant Condition for Setting Healthcare Priorities’, Social Science & Medicine, 68: 22472255.
Ham C. (1997), ‘Priority Setting in Health Care: Learning from International Experience’, Health Policy, 42: 4966.
Hamilton L. (2003), The Political Philosophy of Needs, Cambridge: Cambridge University Press.
Hasman A., Hope T., and Osterdal P. (2006), ‘Health Care Need: Three Interpretations’, Journal of Applied Philosophy, 2: 143156.
Hodgson G. (2008), ‘An Institutional and Evolutionary Perspective on Health Economics’, Cambridge Journal of Economics, 32: 235256.
Hodgson G. (2009), ‘Towards an Alternative Economics of Health Care’, Health Economics, Policy and Law, 4: 99114.
Hurley J. (2000), ‘An Overview of the Normative Economics of the Health Sector’, in Culyer A. and Newhouse J. (eds.), Handbook of health economics, vol. 1A, The Netherlands: North Holland, pp. 56118.
Jan S. (1998), ‘Holistic Approach to the Economic Evaluation of Health Programmes Using Institutionalist Methodology’, Social Science and Medicine, 47: 15651572.
Korica M. and Molloy E. (2010), ‘Making Sense of Professional Identities: Stories of Medical Professionals and New Technologies’, Human Relations, 63 (12): 18791901.
Lancsar E., Wildman J., Donaldson C., Ryan M., and Baker R. (2011), ‘Deriving Distributional Weights for QALYs Through Discrete Choice Experiments’, Journal of Health Economics, 30: 466478.
Leonard C., Stordeur S., and Robertfroid D. (2009), ‘Association Between Physician Density and Health Care Consumption: A Systematic Review of the Evidence’, Health Policy, 9: 121134.
Maarse H. and Paulus A. (2003), ‘Has Solidarity Survived? A Comparative Analysis of the Effect of Social Health Insurance Reform in Four European Countries’, Journal of Health Politics, Policy and Law, 28: 585614.
Massé R. (2005), ‘Les Fondements Ethiques et Anthropologiques d'une Participation du Public en Santé Publique’, Ethique Publique, 7: 107124.
McIntyre D. and Mooney G. (2007), The Economics of Health Equity, Cambridge: Cambridge University Press.
McKie J. and Richardson J. (2000), ‘The Rule of Rescue’, Social Science & Medicine, 56: 24072419.
McMaster R. (2002), ‘A Socio-Institutionalist Critique of the 1990s’ Reforms of the UK's National Health Service’, Review of Social Economy, 60 (3): 403433.
McMaster R. (2007), ‘On the Need for Heterodox Health Economics’, Post-Autistic Economics Review, 41: 922.
Menzel P. (1999), ‘How Should What Economists Call “Social Values” be Measured?’,Journal of Ethics, 3: 249273.
Mooney G. (1998), ‘Communitarian Claims as an Ethical Basis for Allocating Health Care Resources’, Social Sciences and Medicine, 47 (9): 11711180.
Mooney G. (2001), ‘Communitarianism and Health Economics’, in Davis (ed.), The Social Economics of Health Care, London: Routledge, pp. 4059.
Mooney G. (2005), ‘Communitarian Claims and Community Capabilities: Furthering Priority Setting?’, Social Sciences and Medicine, 60: 247255.
Mooney G. (2009), ‘Is it Time for Health Economists to Rethink Equity and Access?’, Health Economics, Policy and Law, 4 (2): 209221.
Mooney G. (2010), Challenging Health Economics, Oxford: Oxford University Press.
Nguyen-Kim L., Or Z., Paris V., and Sermet C. (2005), ‘The Politics of Drug Reimbursement in England, France and Germany’, IRDES Health Economics Letter, 99: 14.
Nord E., Pinto L., Richardson J., Menzel P., and Ubel P. (1999), ‘Incorporating Societal Concerns for Fairness in Numerical Valuations of Health Programmes’, Health Economics, 8: 2539.
Olsen J. A., Richardson J., Dolan P., and Menzel P. (2003), ‘ The Moral Relevance of Personal Characteristics in Setting Health Care’, Social Science & Medicine, 57: 11631172.
Peacock S., Mitton C., Bate A., McCoy B., and Donaldson C. (2009), ‘Overcoming Barriers to Priority Setting Using Interdisciplinary Methods’, Health Policy, 92: 124132.
Robinson R. (1999), ‘Limits to Rationality: Economics, Economists and Priority Setting’, Health Policy, 49: 1326.
Sabik L. and Lie R. (2008), ‘Priority Setting in Health Care: Lessons from the Experiences of Eight Countries’, International Journal for Equity in Health, 7: 113.
Saltman R. (2002), ‘Regulating Incentives: The Past and Present Role of the State in Health Care Systems’, Social Science and Medicine, 54: 16771694.
Sassi F. (2003), ‘Setting Priorities for the Evaluation of Health Interventions: When Theory does not Meet Practice’, Health Policy, 63: 141154.
Schreyogg J., Stargardt T., Velasco-Garrido M., and Busse R. (2005), ‘Defining the Health Benefit Basket in Nine European Countries’, European Journal of Health Economics, 1: 210.
Sen A. K. (1977), ‘Rational Fools: A Critique of the Behavioural Foundations of Economic Theory’, Philosophy and Public Affairs, 6 (4): 317–44.
Sen A. K. (1991), On Ethics and Economics, Oxford: Wiley-Blackwell.
Shah K. (2009), ‘Severity of Illness and Priority Setting in Healthcare: A Review of the Literature’, Health Policy, 93: 7784.
Stolk E., Pickee S., Ament A., and Busschbach J. (2005), ‘Equity in Health Care Prioritization: An Empirical Inquiry into Social Value’, Health Policy, 74: 343355.
The European Journal of Health Economics (2005), ‘Special Issue Healthbasket’, 6, Supplement: 2–23.
Wiggins D. (1987), ‘Claims of Need’, in Wiggins D. (ed.), Needs, Values, Truth: Essays In the Philosophy of Value, Oxford: Basil Blackwell, pp. 157.
Williams A. (1997), ‘Intergenerational Equity: An Exploration of the ‘Fair Innings’ Argument’, Health Economics, 6 (2): 117132.
Williams B. (1973), ‘The Idea of Equality’ in Williams B. (ed.) Problems of the Self, Cambridge: Cambridge University Press, pp. 230249.
Williams B. (1981)[1974–1975], ‘The Truth in Relativism’, in Williams B. (ed.) Moral Luck, Cambridge: Cambridge University Press, pp. 132143.
Williams B. (1995)[1983], ‘What does Intuitionism Imply?’, in Williams B. (ed.), Making Sense of Humanity, Cambridge: Cambridge University Press, pp. 182191.
Wiseman V., Mooney G., Berry G., and Tang K. (2003), ‘Involving the General Public in Priority Setting Experiences from Australia’, Social Science & Medicine, 56: 10011012.
Wynand P. and Van de Ven M. (1996), ‘Market-Oriented Health Care Reforms: Trends and Future Options’, Social Science and Medicine, 43: 655666.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Journal of Institutional Economics
  • ISSN: 1744-1374
  • EISSN: 1744-1382
  • URL: /core/journals/journal-of-institutional-economics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Full text views

Total number of HTML views: 3
Total number of PDF views: 33 *
Loading metrics...

Abstract views

Total abstract views: 202 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 20th January 2018. This data will be updated every 24 hours.