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The need to increase collective participation in health care decision-making is one of the main health reform issues in publicly financed health systems. The present article examines the arguments for collective participation, the means for improving it and the methods available to elicit collective preferences concerning health programs to be financed by the health system. We review the various collective participation tools, as well as the preference elicitation methods assist priority setting in collectively funded health care systems. Finally, the paper suggests some policy implications for policy making design in Spain.