The No-Destination Ship of Priority-Setting in Healthcare: A Call for More Democracy

In dealing with scarcity of resources within healthcare systems, decisionmakers inevitably have to make choices about which services to fund. Setting priorities represents a challenging task that requires systematic, explicit and transparent methodologies with focus on economic efficiency. In addition, the engagement of the general public in the process of decisionmaking has been regarded as one of the most important aspects of the management of publiclyfunded health systems in liberal democracies. In the current essay, we aim to discuss the problematics of public engagement in the process of resource allocation and prioritysetting within the context of publiclyfunded health systems. Our central argument is that although there may be a conflict between democratic mechanisms of citizen participation and economic efficiency, in the extrawelfarist sense, expected for/from the system, the solution for this tension does not seem to rely on more or novel authoritative technocratic approaches, but rather on the deepening and betterment of democratic participation.