The people principle in Australian health care.

n the wake of Menadue’s call for setting principles to underpin our health care system, one key principle that members of “citizens’ juries” advocate is that the appropriate group to set the principles are citizens! Health services are first and foremost social institutions — that is, not just there for the people, but to be based on the values of the people. I have facilitated a number of these citizens’ juries. They are a form of deliberative democracy. They bring together randomly selected citizens; and it is crucial that they are randomly selected, not hand-picked or self-selected. It is emphasised to the members of these juries that they are there as citizens, not consumers, and if the focus is, say, the Western Australian health service, that they are there as citizens of Western Australia, and not just of their home towns of Bunbury or Broome. They are given good information by experts whom they can quiz about health, health care services and resource availability. They are then asked to deliberate on what sorts of principles they want to guide their health services. It seems difficult to argue against this idea of “the people” setting these principles. The issues involved are not technical ones. These principles might include value for money (efficiency); equity (and how this is defined and how important it is); transparency in decision making; prevention and its relative importance compared with treatment; and so on. Interestingly, in my experience, the people on these juries just love to act as citizens! They act responsibly and with pride in the role. Two things are clear on the basis of the results of six juries in which I have been a facilitator. First, the citizens’ values and the relative weights they attach to them are broadly consistent across different juries. They want better access to services, especially a reduction of the barriers caused by a lack of awareness of where and how to get services; improved equity, particularly for Aboriginal people; and more emphasis on public health and prevention. Key propositions