The growing privatization of healthcare has led to the introduction of prioritisation strategies that aim to ensure complete health coverage for specific patient groups, or for certain types of care, at the expense of privatising others. These priorities are a necessary component of the overall strategy of privatization of healthcare. They are determined by default and tend not to solve the problems that they are designed to address. We develop an alternative, more positive, approach to prioritisation which makes the selection of priorities a policy objective. Prioritisation is an inherently normative activity that draws on ethical frameworks of justification and converts them into specific policy mechanisms following a process of political arbitration. We describe this process by analysing a variety of European prioritisation mechanisms. We then deploy the philosophical notion of vital need in order to identify those healthcare needs that should remain publicly financed.