Nestle's violation of international marketing code

Priority setting in health careOf course we should ask the tax payer 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 illinformed 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 health of others.This kind of asymmetrical information can lead well meaning clinicians, managers, and policymakers to provide inefficient healthcare services, poorly in tune with patients' values.That is why health economists have devoted considerable energy to developing methods of valuing the effects of treatments from the patient's point of view.That is also why health economists are now devoting energy to developing methods of consulting patients about their values concerning priority setting.Asymmetrical information about facts can cause inefficiency in a private system, which is why we need a public system.Asymmetrical information about values can cause inefficiency in a public system, which is why we need to include the public in healthcare priority setting.Efficient decision making requires the use of best available information about facts and values.Our experience in conducting preference elicitation studies suggests that asking the taxpayer can be a fruitful source of information about the latter-and that public opinions are more sophisticated, and less predictable, than Torgerson and Gosden like to think.