Interpreting public input into priority-setting: the role of mediating institutions

Discussions about public participation in health priority-setting have tended to assume that the best type of information about public values is that in which the public 'speaks for itself'. However, wherever public input has been used in priority-setting, the way in which it is used is far from transparent. Those jurisdictions that have initiated priority-setting processes have been characterised by the substantial involvement of 'mediating bodies' i.e. bodies such as the Oregon Health Services Commission or the New Zealand National Health Committee, that take on the role of interpreting information about public values. The information that they interpret is usually presented in a highly ambiguous form and most definitely does not 'speak for itself'. In the priority-setting literature, however, little attention has been paid to the role of these bodies and the way in which they interpret and digest information about public values. This article argues that these bodies are essential, but that their decision-making processes are necessarily opaque and should not be judged according to the criterion of transparency.