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Between consensus and contestation.

Albert Weale1

  • 1Department of Political Science, University College London, London, UK.

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Summary
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This paper explores two democratic theories, consensual and agonistic, to understand public participation in healthcare priority setting. It highlights how agonistic theory views priority setting as managing inclusions and exclusions, differing from consensus-based approaches.

Keywords:
Agonistic democracyDeliberative democracyPriority settingPublic participation

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Area of Science:

  • Political Science
  • Health Services Management
  • Public Health Policy

Background:

  • Discussions on public participation and priority setting in healthcare often assume underlying democratic theories.
  • Understanding these theoretical underpinnings is crucial for effective policy and management.

Purpose of the Study:

  • To discuss two distinct theories of democracy: consensual and agonistic.
  • To illuminate the difference between institutionalized and contestatory public participation.
  • To analyze their implications for priority setting in healthcare.

Main Methods:

  • Theoretical reconstruction of public participation in healthcare priority setting.
  • Drawing upon the works of deliberative theorist Habermas and agonism theorist Mouffe.

Main Results:

  • Consensual and agonistic theories offer different frameworks for understanding priority setting.
  • Agonistic democratic theory frames priority setting as a system of inclusions and exclusions.
  • This contrasts with the typical deliberative approach focused on determining a consensus of social values.

Conclusions:

  • Explicitly identifying theoretical assumptions in public participation practices reveals their scope and limitations.
  • Recognizing implicit choices in political participation is valuable for health services management.