title: Acceptable health and priority weighting: Discussing a reference-level approach using sufficientarian reasoning.
abstract: Health care systems are challenged in allocating scarce health care resources, which are typically insufficient to fulfil all health care wants and needs. One criterion for priority setting may be the 'acceptable health' approach, which suggests that society may want to assign higher priority to health benefits in people with "unacceptable" than in people with "acceptable" health. A level of acceptable health then serves as a reference point for priority setting. Empirical research has indicated that people may be able and willing to define health states as "unacceptable" or "acceptable", but little attention has been given to the normative implications of evaluating health benefits in relation to a reference level of acceptable health. The current paper aims to address this gap by relating insights from the distributive justice literature, i.e. the sufficientarian literature, to the acceptable health approach, as we argue that these approaches are related. We specifically focus on the implications of an 'acceptability' approach for priority weighting of health benefits, derived from sufficientarian reasoning and debates, and assess the moral implications of such weighting.
authors.affiliation: Erasmus University Rotterdam, Institute of Health Policy & Management, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Wouters
authors.affiliation: Erasmus University Rotterdam, Institute of Health Policy & Management, The Netherlands; Erasmus University Rotterdam, Erasmus School of Economics, The Netherlands. Electronic address: vanexel@bmg.eur.nl.
authors.forename: N J A
authors.initials: NJA
authors.lastname: van Exel
authors.affiliation: Erasmus University Rotterdam, Erasmus School of Economics, The Netherlands.
authors.forename: K I M
authors.initials: KIM
authors.lastname: Rohde
authors.affiliation: Erasmus University Rotterdam, Faculty of Philosophy, The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Vromen
authors.affiliation: Erasmus University Rotterdam, Institute of Health Policy & Management, The Netherlands.
authors.forename: W B F
authors.initials: WBF
authors.lastname: Brouwer
mesh_terms: D015276:Health Care Rationing / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D006292:Health Priorities / Q000706:statistics & numerical data / Q000639:trends*; D006295:Health Resources / Q000600:supply & distribution; D006801:Humans; D040841:Resource Allocation / Q000379:methods* / Q000706:statistics & numerical data; D012935:Social Justice
keywords: Acceptable health; Distributive justice; Health care priority setting; Priority weights; Resource allocation; Sufficientarianism