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Exploring Theory for Citizens' Preferences in Health Policy : The Contribution of Health Policy Cultures to Understanding the Roles of Public and Private Health Service Providers

Kylänen, Marika (Department of Health and Social Management, Faculty of Social Sciences and Business, University of Eastern Finland, Kuopio, Finland ) ; Vuori, Jari (Department of Health and Social Management, Faculty of Social Sciences and Business, University of Eastern Finland, Kuopio, Finland ) ; Allen, Pauline (Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK ) ;
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    Preferences have been analyzed extensively in health care, but few studies have examined how culture driven preference formation may impact on resource allocation decisions in public and private health service delivery. This paper explores and develops a theoretical framework that distinguishes different approaches to institutionally and culturally informed preferences. The analysis shows that the appropriate approach depends on normative considerations and the particular health policy context which it is applied. In particular health policy cultures, mediating culture driven preferences (such as fatalism, hierarchism, individualism, egalitarianism and autonomy) which have not been used as part of health policy analysis before, challenge the roles of public and private health service providers. In view of the scarcity of studies in this field, the authors suggest a rationale for studies that enhance the understanding of how health policy cultures are embedded in normative health policy and propose a research agenda on cultural biases.


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