The Construction of Agency in Practice
Edited by Göran Sundström, Linda Soneryd and Staffan Furusten
Chapter 7: Democratic Priority Setting? Organizing Multiple Stakeholders to Make Decisions in the Healthcare Sector
Ebba Sjögren and Karin Fernler This chapter focuses on efforts to enact stakeholder participation in decisionmaking processes, as illustrated by a comparison of two examples of priority setting in the Swedish healthcare sector. Healthcare priorities have historically been an indirect result of ordinary political budgetary processes, and the outcome of decision making by individual medical practitioners. Thus in contrast to Göran Sundström’s chapter on forest-sector objectives, institutionalized forms for stakeholder participation did not characterize these two examples. On the contrary, the value of broad stakeholder involvement is relatively new in the field of healthcare priorities. In recent years it has been increasingly argued that more systematic and transparent processes of priority setting should replace the more traditionally closed processes by which the healthcare sector has operated (Ham 1997, Daniels and Sabin 2002). The need for broad participation in setting healthcare priorities has been argued on several grounds: normative, substantive and instrumental (cf. Stirling 2005). Broad participation is a desirable value in democratically organized societies. In addition to this normative justification, broad participation is argued for on the grounds that one’s social knowledge, values and meanings should determine the outcome of prioritization decisions. To reflect societal values – and thereby ensure substantially better outcomes – requires the participation of a wide variety of actors. A third justification has been that broad participation is needed in order to gain a general understanding of and acceptance for the outcomes of priority-setting processes. In other words, the instrumental capacity to deliver socially credible...
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