Intended for healthcare professionals


Priority setting in health care

BMJ 2000; 321 doi: (Published 14 October 2000) Cite this as: BMJ 2000;321:954

Of course we should ask the tax payer

  1. Richard Cookson, senior lecturer in health economics,
  2. Paul Dolan, reader in health economics
  1. School of Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ
  2. School of Health and Related Research and Department of Economics, University of Sheffield, Sheffield S1 4DA
  3. Health Policy and Economic Research Unit, BMA House, London WC1H 9JP
  4. Centre for Health Economics and Department of Health Studies, University of York, York YO10 5DD
  5. National Primary Care Research and Development Centre, University of Manchester, Manchester M13 9PL

    EDITOR—Torgerson and Gosden argue that eliciting public views on healthcare priority setting is a waste of money.1 It is implicit in their argument that the many health economists who dabble in this allegedly inefficient activity should know better. As health economists and practitioners of the dark art of including the public in priority setting, we believe that we ought to respond to this charge.

    The problem with Torgerson and Gosden's argument is that it does not distinguish between facts and values. It seems reasonable to assume that patients normally know less than clinicians about the facts concerning the effects of different treatments. As Torgerson and Gosden argue, this form of asymmetric information is one reason why many British health economists believe that public funding of health care is more efficient than private funding, which provides clinicians with a profit motive for supplying unnecessary treatments to ill-informed patients.

    Torgerson and Gosden assert that patients generally know less than specialists about the “facts” concerning the effects of alternative priority setting decisions, and they conclude that setting priorities on the basis of ill-informed opinions is inefficient. What Torgerson and Gosden do not recognise, however, is the possibility that patients generally know more than specialists about their own values concerning their health and the …

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