IDEAS home Printed from https://ideas.repec.org/a/sae/pophec/v14y2015i1p23-52.html
   My bibliography  Save this article

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

Author

Listed:
  • 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
    as

    Download full text from publisher

    File URL: https://journals.sagepub.com/doi/10.1177/1470594X13497670
    Download Restriction: no
    File URL: https://libkey.io/10.1177/1470594X13497670?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    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. Anonymous, 1948. "World Health Organization," International Organization, Cambridge University Press, vol. 2(2), pages 374-377, June.
    3. Amartya Sen, 2005. "Human Rights and Capabilities," Journal of Human Development and Capabilities, Taylor & Francis Journals, vol. 6(2), pages 151-166.
    4. Anonymous, 1948. "World Health Organization," International Organization, Cambridge University Press, vol. 2(1), pages 138-140, February.
    5. 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.
    6. 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.
    7. Anand, Paul & Dolan, Paul, 2005. "Equity, capabilities and health," Social Science & Medicine, Elsevier, vol. 60(2), pages 219-222, January.
    8. 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.
    9. Broome,John, 1999. "Ethics out of Economics," Cambridge Books, Cambridge University Press, number 9780521642750, September.
    10. Richard Cookson, 2005. "QALYs and the capability approach," Health Economics, John Wiley & Sons, Ltd., vol. 14(8), pages 817-829, August.
    11. 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.
    12. Amartya Sen, 2002. "Why health equity?," Health Economics, John Wiley & Sons, Ltd., vol. 11(8), pages 659-666, December.
    13. 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.
    14. Anonymous, 1948. "World Health Organization," International Organization, Cambridge University Press, vol. 2(3), pages 540-542, September.
    15. 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.
    16. Aki Tsuchiya, 2000. "QALYs and ageism: philosophical theories and age weighting," Health Economics, John Wiley & Sons, Ltd., vol. 9(1), pages 57-68, January.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Marco Ricardo Téllez Cabrera, 2018. "Giving arguments to operationalize health capabilities in economic evaluations of health interventions," Journal of Social and Economic Development, Springer;Institute for Social and Economic Change, vol. 20(2), pages 240-255, October.
    2. Coast, Joanna & Smith, Richard D. & Lorgelly, Paula, 2008. "Welfarism, extra-welfarism and capability: The spread of ideas in health economics," Social Science & Medicine, Elsevier, vol. 67(7), pages 1190-1198, October.
    3. Simon, Judit & Anand, Paul & Gray, Alastair & Rugkåsa, Jorun & Yeeles, Ksenija & Burns, Tom, 2013. "Operationalising the capability approach for outcome measurement in mental health research," Social Science & Medicine, Elsevier, vol. 98(C), pages 187-196.
    4. Odelia Koh & Jeannette Lee & Maudrene L S Tan & E-Shyong Tai & Ce Jin Foo & Kok Joon Chong & Su-Yen Goh & Yong Mong Bee & Julian Thumboo & Yin-Bun Cheung & Avjeet Singh & Hwee-Lin Wee, 2014. "Establishing the Thematic Framework for a Diabetes-Specific Health-Related Quality of Life Item Bank for Use in an English-Speaking Asian Population," PLOS ONE, Public Library of Science, vol. 9(12), pages 1-12, December.
    5. Fielden, Sarah J. & Rusch, Melanie L. & Masinda, Mambo Tabu & Sands, Jim & Frankish, Jim & Evoy, Brian, 2007. "Key considerations for logic model development in research partnerships: A Canadian case study," Evaluation and Program Planning, Elsevier, vol. 30(2), pages 115-124, May.
    6. Olga Pakholok, 2013. "The Idea of Healthy Lifestyle and Its Transformation Into Health-Oriented Lifestyle in Contemporary Society," SAGE Open, , vol. 3(3), pages 21582440135, August.
    7. Viola, Lora Anne, 2008. "WHO says competition is healthy: How civil society can change IGOs [Die WHO sagt: Wettbewerb ist gesund. Wie Zivilgesellschaft IGOs verändern kann]," Discussion Papers, Research Unit: Global Governance SP IV 2008-307, WZB Berlin Social Science Center.
    8. Barrington, D.J. & Sridharan, S. & Shields, K.F. & Saunders, S.G. & Souter, R.T. & Bartram, J., 2017. "Sanitation marketing: A systematic review and theoretical critique using the capability approach," Social Science & Medicine, Elsevier, vol. 194(C), pages 128-134.
    9. Paul Anand & Laurence S. J. Roope & Anthony J. Culyer & Ron Smith, 2020. "Disability and multidimensional quality of life: A capability approach to health status assessment," Health Economics, John Wiley & Sons, Ltd., vol. 29(7), pages 748-765, July.
    10. Letizia Appolloni & Alberto Giretti & Maria Vittoria Corazza & Daniela D’Alessandro, 2020. "Walkable Urban Environments: An Ergonomic Approach of Evaluation," Sustainability, MDPI, vol. 12(20), pages 1-31, October.
    11. João M. S. Carvalho & Célio A. A. Sousa, 2018. "Is Psychological Value a Missing Building Block in Societal Sustainability?," Sustainability, MDPI, vol. 10(12), pages 1-14, December.
    12. Modranka Emilia & Suchecka Jadwiga, 2014. "The Determinants Of Population Health Spatial Disparities," Comparative Economic Research, Sciendo, vol. 17(4), pages 173-185, December.
    13. Völker, Sebastian & Kistemann, Thomas, 2013. "Reprint of: “I'm always entirely happy when I'm here!” Urban blue enhancing human health and well-being in Cologne and Düsseldorf, Germany," Social Science & Medicine, Elsevier, vol. 91(C), pages 141-152.
    14. Heather J. Sutherland & Hilary Llewellyn-Thomas & Norman F. Boyd & James E. Till, 1982. "Attitudes Toward Quality of Survival," Medical Decision Making, , vol. 2(3), pages 299-309, August.
    15. Pilar Sanjuán & María Ávila, 2019. "The Mediating Role of Coping Strategies on the Relationships Between Goal Motives and Affective and Cognitive Components of Subjective Well-Being," Journal of Happiness Studies, Springer, vol. 20(4), pages 1057-1070, April.
    16. Jozef Bavoľár & Oľga Orosová, 2015. "Decision-making styles and their associations with decision-making competencies and mental health," Judgment and Decision Making, Society for Judgment and Decision Making, vol. 10(1), pages 115-122, January.
    17. Roberto Adriani, 2019. "The Evolution of Fake News and the Abuse of Emerging Technologies," European Journal of Social Sciences Articles, Revistia Research and Publishing, vol. 2, ejss_v2_i.
    18. Amaresh Panda & Sanjay Mohapatra, 2021. "Online Healthcare Practices and Associated Stakeholders: Review of Literature for Future Research Agenda," Vikalpa: The Journal for Decision Makers, , vol. 46(2), pages 71-85, June.
    19. Marco Fuscaldo, 2012. "Physical limitations, depressive symptoms and cognitive problems: exploring the complex structure of un-health among older people in Italy," Center for the Analysis of Public Policies (CAPP) 0098, Universita di Modena e Reggio Emilia, Dipartimento di Economia "Marco Biagi".
    20. Tim Lomas & Kate Hefferon & Itai Ivtzan, 2015. "The LIFE Model: A Meta-Theoretical Conceptual Map for Applied Positive Psychology," Journal of Happiness Studies, Springer, vol. 16(5), pages 1347-1364, October.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:sae:pophec:v:14:y:2015:i:1:p:23-52. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: SAGE Publications (email available below). General contact details of provider: .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.