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Communitarian claims and community capabilities: furthering priority setting?

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  • Mooney, Gavin

Abstract

Priority setting in health care is generally not done well. This paper draws on ideas from Amartya Sen and Martha Nussbaum and adds some communitarian underpinnings to provide a way of improving on current uses of program budgeting and marginal analysis (PBMA) in priority setting. The paper suggests that shifting to a communitarian base for priority setting alters the distribution of property rights over health service decision making and increases the probability that recommendations from PBMA exercises will be implemented. The approach is built on a paradigm which departs from three tenets of welfarism as it is normally conceived: (i) individuals qua individuals seek to maximise their individual utility/well-being; (ii) individuals want to do this; and (iii) it is the values of individuals qua individuals that count. Some of the problems of PBMA, as it has been applied to date, are highlighted. It is argued that these are due largely to a lack of 'credible commitment'. Bringing in the community and communitarian values to PBMA priority setting exercises can help to overcome some of the barriers to getting PBMA recommendations implemented. The approach has the merit of reflecting Sen's concept of capabilities (but extending that to a community level). It avoids the often consequentialist base of a conventional welfarist framework, and it allows community values as opposed to individual values to come to the fore. How to elicit communitarian values is explored.

Suggested Citation

  • Mooney, Gavin, 2005. "Communitarian claims and community capabilities: furthering priority setting?," Social Science & Medicine, Elsevier, vol. 60(2), pages 247-255, January.
  • Handle: RePEc:eee:socmed:v:60:y:2005:i:2:p:247-255
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    Cited by:

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    2. Schoon, Rebecca & Chi, Chunhuei, 2022. "Integrating Citizens Juries and Discrete Choice Experiments: Methodological issues in the measurement of public values in healthcare priority setting," Social Science & Medicine, Elsevier, vol. 309(C).
    3. Giulia Greco & Paula Lorgelly & Inthira Yamabhai, 2016. "Outcomes in Economic Evaluations of Public Health Interventions in Low‐ and Middle‐Income Countries: Health, Capabilities and Subjective Wellbeing," Health Economics, John Wiley & Sons, Ltd., vol. 25(S1), pages 83-94, February.
    4. Lu Fan & Swarn Chatterjee & Jinhee Kim, 2022. "An Integrated Framework of Young Adults’ Subjective Well-Being: The Roles of Personality Traits, Financial Responsibility, Perceived Financial Capability, and Race," Journal of Family and Economic Issues, Springer, vol. 43(1), pages 66-85, March.
    5. Schoon, Rebecca & Chi, Chunhuei & Liu, Tsai-Ching, 2022. "Quantifying public preferences for healthcare priorities in Taiwan through an integrated citizens jury and discrete choice experiment," Social Science & Medicine, Elsevier, vol. 315(C).
    6. Brouwer, Werner B.F. & Culyer, Anthony J. & van Exel, N. Job A. & Rutten, Frans F.H., 2008. "Welfarism vs. extra-welfarism," Journal of Health Economics, Elsevier, vol. 27(2), pages 325-338, March.
    7. Ruben Andreas Sakowsky, 2021. "Disentangling the welfarism/extra‐welfarism distinction: Towards a more fine‐grained categorization," Health Economics, John Wiley & Sons, Ltd., vol. 30(9), pages 2307-2311, September.
    8. Richardson, Jeff & McKie, John, 2007. "Economic evaluation of services for a National Health Scheme: The case for a fairness-based framework," Journal of Health Economics, Elsevier, vol. 26(4), pages 785-799, July.
    9. R. Scott Braithwaite & Mark S. Roberts, 2021. "Are Discount Rates Too High? Population Health and Intergenerational Equity," Medical Decision Making, , vol. 41(2), pages 245-249, February.

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