This study analyses the role of the payment vehicle when conducting non-market valuations of health care services using stated preference methods. Based on a contingent valuation study conducted in Denmark encompassing more than 3400 respondents three important conclusions are drawn. Firstly, it is found that the valuation of a publicly financed ambulance helicopter service is higher than for an identical privately financed service. Secondly, the results suggest that the public premium is likely to be partly driven by altruistic preferences, and that some citizens value access to this type of service for all. An important driver is also perceptions of quality of services across the private and public sector. Finally, it is shown that exclusion of protest bidders is problematic and may bias welfare estimates. The take home message is that it is difficult to isolate the value of a good per se, and that analysts should take care in applying the payment vehicle that is likely to be applied in real life when valuing non-market goods. There has been little awareness of the importance of choice of payment vehicle in the literature to date.

The Italian Health care System provides universal coverage for comprehensive health services and is mainly financed through general taxation. Since the early 1990s, a strong decentralization policy has been adopted in Italy and the state has gradually ceded its jurisdiction to regional governments, of which there are twenty. These regions now have political, administrative, fiscal and organizational responsibility for the provision of health care. This paper examines the different governance models that the regions have adopted and investigates the performance evaluation systems (PESs) associated with them, focusing on the experience of a network of ten regional governments that share the same PES. The article draws on the wide range of governance models and PESs in order to design a natural experiment. Through an analysis of 14 indicators measured in 2007 and in 2012 for all the regions, the study examines how different performance evaluation models are associated with different health care performances and whether the network-shared PES has made any difference to the results achieved by the regions involved. The initial results support the idea that systematic benchmarking and public disclosure of data are powerful tools to guarantee the balanced and sustained improvement of the health care systems, but only if they are integrated with the regional governance mechanisms.

In spite of the vast number of studies measuring economic efficiency in health care, there has been little take-up of this evidence by policy-makers to date. This study provides an illustration of how a system-level study drawing on best practice in empirical measurement of efficiency may be of practical use to health system decision makers and managers. We make use of the rich data available in Canada to undertake a robust two-stage data envelopment analysis to calculate efficiency at the regional (sub-provincial) level. Decisions about what the health system produces (the outcome to measure efficiency against) and what are the resources it has to produce that outcome were based on interviews and consultation with health system decision makers. Overall, we find large inefficiencies in the Canadian health care system, which could improve outcomes (here, measured as a reduction in treatable causes of death) by between 18 and 35% across our analyses. Also, we find that inefficiencies are the result of three main sets of factors that policy makers could pay attention to: management factors, such as hospital re-admissions; public health factors, such as obesity and smoking rates; and environmental factors such as the population’s average income.

We outline key conclusions of the World Health Organisation's report 'Making Fair Choices on the Path to Universal Health Coverage (UHC)'. The Report argues that three principles should inform choices on the path to UHC: I. Coverage should be based on need, with extra weight given to the needs of the worse off; II. One aim should be to generate the greatest total improvement in health; III. Contributions should be based on ability to pay and not need. We describe how these principles determine which trade-offs are (un)acceptable. We also discuss which institutions contribute to fair and accountable choices.

Making Fair Choices on the Path to Universal Health Coverage [UHC; World Health Organization (WHO), 2014] is to be welcomed because tackling the relationship between cost-effectiveness and fairness has been given too little attention in policy-making. The consensus that universal coverage is a good thing quickly disperses as the concept is translated into working national policies and local delivery processes. As Weale (2014) and Rumbold and Wilson (2014) point out, seeking practical solutions can lead to the re-exploration of previous givens and result in unexpected ethical and philosophical consequences. While the basic premise underlying the discussion on the ethics of resource concurs with the view that equity is always at odds with efficiency, this is not inevitable as the authors of the report point out in their analysis – a view more fully explored by Culyer (2006). The present report is a welcome attempt to reconcile, as countries progress to UHC, ethical norms with the reality of setting priorities, involving what to pay for and under what circumstances.

In this article we consider the conclusions and recommendations of the World Health Organisation’s report Making Fair Choices from a philosophical perspective. In particular we reflect on the report’s return to substantive claims about justice in the allocation of health care resources and its argument that certain trade-offs are ‘generally unacceptable’.