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Abstract

The provision of health care in contemporary developed societies has become a so-called “wicked problem.” Tackling the many important challenges is a daunting task—so much so, in fact, that it may prove to be a “mission impossible.” This reality has significant implications for the crafting of health care reforms and policies. Moreover, and more fundamentally, there exists no widely accepted standard by which to generate, evaluate, and prioritize reform and policy proposals. In view of these difficulties, turning to the public for guidance may be the wisest course of action. Specifically, a democratic mechanism is needed by which the public can consider a range of policy directions and can deliberate the consequences and trade-offs in view of people’s values and priorities. In short, some form of deliberative democratic exercise is called for. The chief aim of the present article is to highlight the possibilities for bringing the principles and methods of deliberative democracy to bear on health care in Finland, and in particular on developing proposals for reform and policy. The essay consists of four parts. First, I offer a theoretical perspective on deliberative democracy and its potential for dealing with “wicked problems.” Second, I situate the theory in the context of the crisis of the Finnish welfare state. In part three, I consider the relative dearth of existing forms of deliberative democracy in Finland, and present an upcoming Finnish experiment on public deliberation. Finally, in part four, I examine the views of two groups: representatives of Finnish patient and disability NGOs, and a group of Finnish citizens. I ask whether they see the need for or value in increased citizen involvement in the planning of health care reforms and policies.

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