Judging goodness must come before judging quality--but what is the good of health care?

The paper argues first that until it is known what the good of health care is there cannot be a judgement about what is better, and second that until it is known what is better there cannot be a judgement about what is quality. It is further suggested that in judging good and better with respect to health care as a social institution, there is no-one better placed to do this than the community. Too little is currently known about what communities want from their health services. Some suggestions as to how this situation might be improved in both principle and practice are discussed and the notion of 'communitarian claims' linked to conjoint analysis posited as a useful way forward. Such an approach will allow the development of a set of community-based principles--what is called a 'communitarian constitution'--on which to base the direction and objectives of health care.