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Principles of Need and the Aggregation Thesis
Linköping University, Department of Culture and Communication, Culture and Aesthetics. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. (The National Center for Priority Setting in Health Care)
LIME, Stockholm Centre for Healthcare Ethics, Karolinska Institutet, Stockholm, Sweden..
2017 (English)In: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394Article in journal (Refereed) Epub ahead of print
Abstract [en]

Principles of need are constantly referred to in health care priority setting. The common denominator for any principle of need is that it will ascribe some kind of special normative weight to people being worse off. However, this common ground does not answer the question how a plausible principle of need should relate to the aggregation of benefits across individuals. Principles of need are sometimes stated as being incompatible with aggregation and sometimes characterized as accepting aggregation in much the same way as utilitarians do. In this paper we argue that if one wants to take principles of need seriously both of these positions have unreasonable implications. We then characterize and defend a principle of need consisting of sufficientarian elements as well as prioritarian which avoids these unreasonable implications.

Place, publisher, year, edition, pages
Springer, 2017.
Keyword [en]
Aggregation, Needs, Principles of need, Prioritarianism, Priority setting, Sufficiency
National Category
Ethics
Identifiers
URN: urn:nbn:se:liu:diva-144208DOI: 10.1007/s10728-017-0346-6PubMedID: 28866792Scopus ID: 2-s2.0-85028766963OAI: oai:DiVA.org:liu-144208DiVA, id: diva2:1172699
Available from: 2018-01-10 Created: 2018-01-10 Last updated: 2018-05-18Bibliographically approved
In thesis
1. Characterising Needs in Health Care Priority Setting
Open this publication in new window or tab >>Characterising Needs in Health Care Priority Setting
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
En karakterisering av behov i hälso- och sjukvårdsprioriteringar
Abstract [en]

The focus of this thesis is needs in the context of health care priority setting. The notion of needs has a strong standing in health care policy; however, how the idea should be understood more specifically and how it should guide decisions about priority setting remain contentious issues. The aim of this thesis is to explore how needs should be characterised in health care priority setting. This matter is approached by, first, exploring and developing the conceptual structure of health care needs, and second, discussing and suggesting solutions to normative questions that arise when needs are characterised as a distributive principle.

In the first article, the conceptual structure of needs in general and health care needs in particular is explored, and it is argued that a specific characterisation of health care needs is required.

In the second article, the notion of health care needs is explored in relation to preferences for health care within the context of shared decision-making. The paper further discusses a number of queries that arise in the intersection between what the patient needs and what the patient wants.

The third article discusses how a principle of need should handle questions about interpersonal aggregation. The paper characterises a principle of need which strikes a reasonable balance between giving priority to the worst off and the distribution of benefits with regard to interpersonal aggregation.

The fourth article discusses how a principle of need should account for the fact that patients often are badly off due to several conditions rather than one single condition. It is argued that how badly off patients are should be understood as a function of how badly off these patients are when all of their conditions (for which they need health care) are considered.

The frame story provides the terminological, theoretical, contextual, and methodological background for the discussion undertaken in this thesis. The conclusions of the articles are brought together and the discussion extended in the concluding discussion by sketching a number of conditions of adequacy for the concept and principle of need relevant for health care priority setting.  

Abstract [sv]

Den här avhandlingen fokuserar på behov och behovsprinciper inom hälso- och sjukvården. Behov har länge haft en stark ställning inom hälso- och sjukvården men det är omdiskuterat hur begreppet ska förstås mer specifikt och framförallt hur det ska vara vägledande för prioriteringar inom hälso- och sjukvården. Syftet med den här avhandlingen är att karakterisera behov för sådana prioriteringar. Avhandlingen tar sig an detta syfte utifrån två ansatser. För det första, genom att undersöka och utveckla den begreppsliga strukturen hos vårdbehov och, för det andra, genom att diskutera samt ge förslag på lösningar på ett antal normativa frågor som uppstår när vårdbehov skall karakteriseras som en fördelningsprincip.

I den första artikeln undersöks begreppen behov och vårdbehov utifrån den allmänfilosofiska diskussionen om behov. I artikeln karakteriseras begreppet vårdbehov på ett sätt som gör det lämpligt för prioriteringar inom hälsooch sjukvården.

I den andra artikeln utforskas begreppet vårdbehov i relation till önskemål om vård inom ramen för delat beslutsfattande. I artikeln diskuteras också ett antal frågeställningar som aktualiseras i relation till den spänning som kan uppstå mellan patientens behov å ena sidan och patientens önskemål å andra sidan.

I den tredje artikeln behandlas frågan om hur en behovsprincip bör hantera frågor som rör sammanvägning av olika personers behov. I artikeln karakteriseras och försvaras en behovsprincip som balanserar prioritet till de sämst ställda och hur hälsovinster bör fördelas.

I den fjärde artikeln förs en diskussion om hur en behovsprincip bör göra reda för det faktum att patienter ofta lider av samsjuklighet snarare än av ett enskilt tillstånd. I artikeln drivs tesen att hur dåligt ställt en patient har det bör förstås som en funktion av hur dåligt ställt patienten har det när alla patientens tillstånd (för vilka patienten behöver vård) har tagits i beaktande, snarare än hur dåligt ställt patienten har det med avseende på det specifika tillstånd för vilket patienten skall behandlas.

I kappan ges den terminologiska, kontextuella, teoretiska och metodologiska bakgrunden för diskussionen i avhandlingen. I en avslutande diskussion förs slutsatserna från artiklarna samman och diskussionen utvidgas genom att skissera ett antal adekvansvillkor för begreppet vårdbehov och behovsprinciper i vården.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2017. p. 85
Series
Linköping Studies in Arts and Science, ISSN 0282-9800 ; 733Linköping Dissertations on Health and Society, ISSN 1651-1646 ; 26
Keyword
Comorbidity, conceptual analysis, health care, health care needs, interpersonal aggregation, intrapersonal aggregation, multimorbidity, needs, prioritarianism, priority setting, priority to the worse off, rationing, reflective equilibrium, severity, shared decision-making, sufficiency principles, the principle of need, Aggregering, begreppsanalys, behov, behovsprincipen, delat beslutsfattande, hälso- och sjukvård, prioritanism, prioriteringar, reflektivt ekvilibrium, resursfördelning, samsjuklighet, sufficientism, svårighetsgrad, vårdbehov
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-144207 (URN)10.3384/diss.diva-144207 (DOI)9789176853863 (ISBN)
Public defence
2018-01-26, KEY1, Hus KEY, Campus Valla, Linköping, 10:15 (English)
Opponent
Supervisors
Note

I den tryckta versionen är det ena serienamnet felaktigt. I den elektroniska versionen är detta ändrat till korrekt "Linköping Dissertations on Health and Society"

Available from: 2018-01-10 Created: 2018-01-10 Last updated: 2018-01-11Bibliographically approved

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