To the Editor: “What is the health service for?”1 In essence, this is a question of definition and ownership. What is the definition of quality health care and who decides how it is defined? Who are the recipients of health services, the funders, those who stand to lose or benefit from the way in which health care is delivered? The answer is citizens.

When we define quality, we are making a value judgement; we are saying what it is about health care that we consider important and worthy of achieving. In a democratic society, we expect that the values of citizens will be reflected in the definition of health care quality.

The United States Institute of Medicine initiative, “Crossing the quality chasm”, emphasises “patient-centered(ness)” and care “customized according to patient needs and values” as system attributes for delivering quality health care to individuals.2 Yet, a broader perspective is suggested in the following statement on the objectives of health care systems from the World Health Organization:

Implicit in both definitions is knowing what people expect, need and want from their health service. What do Australians expect, need and want from their health service at an individual, local and national level? How can we engage citizens effectively to answer these questions? We need a process of informed public consultation, a process that is constructive, efficient and representative, to guide the vision and values that form the basis of our health system.

Menadue highlights the Canadian Romanow-led Royal Commission as an example of community engagement.1 A similar initiative underlies the United Kingdom’s “Our NHS [National Health Service] our future”, where a process involving consumer consultation has been employed at all levels of health care reform and in the development of an “NHS Constitution”.4 Mooney suggests “citizens’ juries” and a “National Citizens’ Summit”.5 Whatever our Australian national solution, as key stakeholders in the health system, as its patients and its health workforce, citizens need to be given a genuine opportunity to influence and contribute to the future direction of Australian health care.