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Priority setting in public and private health care: a guide through the ideological jungle

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  • ALan Williams

Abstract

Priority setting reflects ideology, and so, more surprisingly, does the quest for “efficiency”. A great deal of the current debate about alternative methods of finance and about reform of management structures, in health services all over the world, purports to be about some notion of efficiency which it is believed we all seek. But efficiency depends on objectives. How important is freedom of choice, what weight is to be given to “need”, how much innovative diversity is compatible with equality of access? This paper presents two polar ideological positions, and outlines the kind of health services each holds up as “ideal”. It is argued that neither ideal is seen in practice, but our views as to what would make a real-world health service more “efficient! Will depend on which ideal we wish it to move towards. But is there any ideologically coherent middle ground which would justify a mixed system? A mixed system is a middle, but it is a muddle we have chosen (and can therefore justify), or is it the unintended by-product of intellectual confusion? This discussion paper is intended to help its readers identify, and come to terms with the consequences of, their own ideology, so that the debate about the merits of rival systems is not conducted on a false appreciation of which issues are “factual” and which are “ideological”.

Suggested Citation

  • ALan Williams, 1988. "Priority setting in public and private health care: a guide through the ideological jungle," Working Papers 036chedp, Centre for Health Economics, University of York.
  • Handle: RePEc:chy:respap:36chedp
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    File URL: http://www.york.ac.uk/media/che/documents/papers/discussionpapers/CHE%20Discussion%20Paper%2036.pdf
    File Function: First version, 1988
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    Citations

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    Cited by:

    1. Maynard, A., 2014. "Contracting for Quality in the NHS," Monographs, Office of Health Economics, number 000073.
    2. van Exel, Job & Baker, Rachel & Mason, Helen & Donaldson, Cam & Brouwer, Werner, 2015. "Public views on principles for health care priority setting: Findings of a European cross-country study using Q methodology," Social Science & Medicine, Elsevier, vol. 126(C), pages 128-137.
    3. Prigge, Jana-Kristin & Dietz, Beatrix & Homburg, Christian & Hoyer, Wayne D. & Burton, Jennifer L., 2015. "Patient empowerment: A cross-disease exploration of antecedents and consequences," International Journal of Research in Marketing, Elsevier, vol. 32(4), pages 375-386.
    4. James, Marilyn, 1999. "Towards an integrated needs and outcome framework," Health Policy, Elsevier, vol. 46(3), pages 165-177, March.
    5. Alan Williams, 1997. "Intergenerational Equity: An Exploration of the ‘Fair Innings’ Argument," Health Economics, John Wiley & Sons, Ltd., vol. 6(2), pages 117-132, March.
    6. Neil J. Buckley & Katherine Cuff & Jeremiah Hurley & Logan McLeod & Robert Nuscheler & David Cameron, 2012. "Willingness‐to‐pay for parallel private health insurance: evidence from a laboratory experiment," Canadian Journal of Economics/Revue canadienne d'économique, John Wiley & Sons, vol. 45(1), pages 137-166, February.
    7. Virginia Wiseman & Craig Mitton & Mary M. Doyle‐Waters & Tom Drake & Lesong Conteh & Anthony T. Newall & Obinna Onwujekwe & Stephen Jan, 2016. "Using Economic Evidence to Set Healthcare Priorities in Low‐Income and Lower‐Middle‐Income Countries: A Systematic Review of Methodological Frameworks," Health Economics, John Wiley & Sons, Ltd., vol. 25(S1), pages 140-161, February.
    8. Mwabu, Germano, 1990. "Financing health services in Africa : an assessment of alternative approaches," Policy Research Working Paper Series 457, The World Bank.
    9. Mandy Ryan, 1994. "Agency in Health Care: Lessons for Economists from Sociologists," American Journal of Economics and Sociology, Wiley Blackwell, vol. 53(2), pages 207-217, April.
    10. Di Matteo, Livio, 2000. "The determinants of the public-private mix in Canadian health care expenditures: 1975-1996," Health Policy, Elsevier, vol. 52(2), pages 87-112, June.
    11. Vick, Sandra & Scott, Anthony, 1998. "Agency in health care. Examining patients' preferences for attributes of the doctor-patient relationship," Journal of Health Economics, Elsevier, vol. 17(5), pages 587-605, October.
    12. Ignacio Abásolo & Miguel Negrín-Hernández & Jaime Pinilla, 2014. "Equity in specialist waiting times by socioeconomic groups: evidence from Spain," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(3), pages 323-334, April.
    13. Crawshaw, Lauren & Fèvre, Sonia & Kaesombath, Lampheuy & Sivilai, Bounlerth & Boulom, Sayvisene & Southammavong, Fongsamouth, 2014. "Lessons from an Integrated Community Health Education Initiative in Rural Laos," World Development, Elsevier, vol. 64(C), pages 487-502.
    14. Shiell, Alan, 1997. "Health outcomes are about choices and values: an economic perspective on the health outcomes movement," Health Policy, Elsevier, vol. 39(1), pages 5-15, January.
    15. Jan Abel Olsen & Jeff Richardson, 2013. "Preferences For The Normative Basis Of Health Care Priority Setting: Some Evidence From Two Countries," Health Economics, John Wiley & Sons, Ltd., vol. 22(4), pages 480-485, April.

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