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Democratic deficit and communication hyper-inflation in health care systems

Lookup NU author(s): Dr Peter Andras, Dr Bruce Charlton



There is a widespread perception of poor performance and reduced trust in relation to health care systems. The roots of this problem are interpreted in terms of the democratic deficit and communication hyper-inflation. The democratic deficit is characterized as a persistent but chronically unsatisfied demand for complete public authority over all significant societal institutions - including the health care system. However, such professional institution systems necessarily perform their functions using specialized internal languages, which are not transparent to external scrutiny. Furthermore, professional institution systems tend to eliminate all subjective and imprecise criteria, such as individual moral values. This situation encourages communication inflation, which describes the large and unpredictable divergence between the real and nominal informational content of communications. Hyper-inflation is generated by the development of morality-free information management subsystems (specifically public relations and advertising) to the extent that 'official' communications convey almost zero reliable information. Reduction of the democratic deficit and control of communication inflation depends upon successful penetration of the health care system by representative public values, including individual morality.

Publication metadata

Author(s): Andras P, Charlton BG

Publication type: Review

Publication status: Published

Journal: Journal of Evaluation in Clinical Practice

Year: 2002

Volume: 8

Issue: 3

Pages: 291-297

Print publication date: 01/08/2002

ISSN (print): 1356-1294

ISSN (electronic): 1365-2753


DOI: 10.1046/j.1365-2753.2002.00354.x

PubMed id: 12164974