Deliberative Processes in Decisions about Health Care Technologies

In the UK and elsewhere, choices about how to allocate health care resources are guided not only by economic calculations, but also by social value judgments such as those relating to equity and fairness. Factors such as uncertainty around key values, operational feasibility and stakeholder interests also need to be considered. The question of how to combine these inputs is central to the field of health care decision making. A continuum of approaches for answering this question exists. At one end are algorithmic and formulaic methods of combining information; at the other end are ‘pure’ deliberative processes. In between are a variety of ‘structured’ deliberative processes that may combine facilitation with the use of decision weights that are generated both by the deliberative process and from outside. The author offers a series of conjectures about the circumstances under which deliberative processes are likely to be useful and the characteristics that they ought to possess in order to be applied successfully in health care decision making.