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Social values and healthcare priority-setting
Edited by Peter Littlejohns, Albert Weale, Kalipso Chalkidou, Yot Teerwattananon and Ruth Faden
1. Introduction
By definition, to set priorities is to give higher importance to some things over others. Priority setting in health aims to determine what, in the context of limited resources, is most important. Priority setting is undertaken at many different levels of decision making, from the highest levels of health politics and management, where overall resources are allocated, to decisions at the bedside where the value of interventions has to be assessed. Priority setting is not unique to the public sector - private insurance engages in priority setting when it determines entitlements and exclusions.
How priorities are set in different institutional and national settings, however, will vary considerably, given that what is thought most important in one society may not be thought most important in another society because of a whole range of social factors, including politics, culture, social demographics, religion and levels of economic development. So, whilst the challenges of priority setting may be common to very many societies, the variety of factors that are taken into account in practical decision making, and how those decisions are shaped by an array of social values is of great interest. The purpose of this paper is to map a set of what seem to be the most significant of those social values as they occur in the context of health care, in order to facilitate the beginnings of an international comparative study of the role social values play in priority-setting decisions.
It has come to be recognized increasingly over recent years that setting health priorities requires not only apparently "technical" judgments such as those around clinical and cost effectiveness, but that it also involves value judgments - and these judgments are social. Social value judgments might be defined as judgments made on the basis of the moral or ethical values of a particular society. Social values can be contrasted with purely moral values in so far as the latter may include values which are not held by a particular society at a particular time (Biron et al. , 2012). This is not, however, to say that social values are relativistic in the philosophical sense, but rather...