Public values, plurality and health care resource allocation: What should we do when people disagree? (..and should economists care about reasons as well as choices?)

Abstract: There are legitimate arguments for taking account of public values in health care priority setting and there are a number of ways of doing so. Health economists have designed surveys of the general population to elicit preferences in relation to different treatment options or outcomes. Such surveys are usually presented as hypothetical choices between treatments for oneself or choices between providing treatments to groups of patients. There is little guidance on what to do when findings indicate substantial disagreement.

Drawing on a body of empirical research investigating social values and ‘end of life’ (i.e. provision of high-cost, life-extending health technologies for people with terminal illnesses) I will present evidence of plurality in public values and raise questions about policy implications in the light of plurality more generally.

Assuming that ‘the public’ will almost always present a number of competing perspectives – both in terms of allegiances with different high-level principles and with respect to specific priority setting questions – how should researchers and policy makers respond? Typically we proceed down one of two routes, broadly: aggregation or deliberation. These have strengths and limitations which will be outlined.

Finally I will propose an empirical framework for discussion, drawing on Sunstein’s ‘Incompletely Theorised Agreements’ and applying that to analysis of public values that could take account of consistency, coherence and consensus. This is a work in progress and I welcome discussion and questions.