COMMUNITARIAN CLAIMS AS AN ETHICAL BASIS FOR ALLOCATING HEALTH-CARE RESOURCES

This paper presents the case for re-examining the most commonly adopte d basis of resource allocation in health care, i.e. need. The key prob lems identified with most needs approaches are (a) defining its precis e meaning, (b) that the community is seldom consulted as to first what constitute needs for health care or second what relative weights are to be attached to health gains aimed at addressing different needs and (c) more generally, proceeding without knowing what the community wan ts the objectives of health care to be. It is suggested that John Broo me's notion of ''claims'', especially what this paper calls ''communit arian claims'', may be helpful in providing a better basis for allocat ing health care resources. Such ''communitarian claims'' allow inter a lia for the community to be involved in setting the social choice rule s with respect to the governance of health care and for determining wh at it is that it (the community) wants from its health service. The li nks to rights are also identified and the advantages of communitarian claims over both a simple concept of need and rights are set out, with out arguing that either needs (or rights) ought necessarily to be aban doned as bases for resource allocation in health care. (C) 1998 Elsevi er Science Ltd. All rights reserved.