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Priority setting in health care: Lessons from the experiences of eight countries

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Sabik, Lindsay M, Lie, Reidar K·2008·International Journal for Equity in Health

DOI 10.1186/1475-9276-7-4PMC PMC2248188

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Abstract

All health care systems face problems of justice and efficiency related to setting priorities for allocating a limited pool of resources to a population. Because many of the central issues are the same in all systems, the United States and other countries can learn from the successes and failures of countries that have explicitly addressed the question of health care priorities.We review explicit priority setting efforts in Norway, Sweden, Israel, the Netherlands, Denmark, New Zealand, the United Kingdom and the state of Oregon in the US. The approaches used can be divided into those centered on outlining principles versus those that define practices. In order to establish the main lessons from their experiences we consider (1) the process each country used, (2) criteria to judge the success of these efforts, (3) which approaches seem to have met these criteria, and (4) using their successes and failures as a guide, how to proceed in setting priorities. We demonstrate that there is little evidence that establishment of a values framework for priority setting has had any effect on health policy, nor is there evidence that priority setting exercises have led to the envisaged ideal of an open and participatory public involvement in decision making.

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Eliciting societal preferences of reimbursement decision criteria for anti cancer drugs in South Korea
Kwon, S., Park, S., Byun, J.-H., & Lee, E. (2016) · Expert Review of Pharmacoeconomics & Outcomes Research · doi:10.1080/14737167.2017.1277144 · Cited by 25
Priority setting in practice: Participants opinions on vertical and horizontal priority setting for reallocation
Waldau, S., Lindholm, L. H., & Wiechel, A. H. (2010) · Health Policy · doi:10.1016/j.healthpol.2010.02.007 · Cited by 24
Setting Priorities For Comparative Effectiveness Research: From Assessing Public Health Benefits To Being Open With The Public
Dubois, R. W., & Graff, J. S. (2011) · Health Affairs · doi:10.1377/hlthaff.2011.0136 · Cited by 24
Commissioning [Integrated] Care in England: An Analysis of the Current Decision Context
Góngora, P., Głogowska, M., Fitzpatrick, R. M., Perera, R., & Tsiachristas, A. (2022) · International Journal of Integrated Care · doi:10.5334/ijic.6693 · Cited by 23
Are patients receiving enough information about healthcare rationing? A qualitative study: Table 1
Owen‐Smith, A., Coast, J., & Donovan, J. (2010) · Journal of Medical Ethics · doi:10.1136/jme.2009.033241 · Cited by 23
“and policymakers around the world have responded to this by introducing policies to set priorities more explicitly.”
Background
Barriers and facilitators to implementing priority setting and resource allocation tools in hospital decisions: A systematic review
Ahumada‐Canale, A., Jeet, V., Bilgrami, A., Seil, E., Gu, Y., & Cutler, H. (2023) · Social Science & Medicine · doi:10.1016/j.socscimed.2023.115790 · Cited by 22
Equity, justice, and social values in priority setting: a qualitative study of resource allocation criteria for global donor organizations working in low-income countries
Kapiriri, L., & Razavi, D. (2022) · International Journal for Equity in Health · doi:10.1186/s12939-021-01565-5 · Cited by 25
What values do the public want their health care systems to use in evaluating technologies?
Buxton, M. J., & Chambers, J. D. (2011) · The European Journal of Health Economics · doi:10.1007/s10198-011-0320-4 · Cited by 21
The Role of Ethics Committees and Ethics Consultation in Allocation Decisions
Strech, D., Hurst, S., & Danis, M. (2010) · Medical Care · doi:10.1097/mlr.0b013e3181e577fb · Cited by 21
“There is relatively broad consensus that the extent of the benefit and of the cost-effectiveness of an available intervention, the severity of the illness, and the availability of an alternative intervention should play a central role in the ethical consideration of rationing decisions.(1,24,29) There is a similarly b…”
Background
Self‐responsibility, rationing and treatment decision making – managing moral narratives alongside fiscal reality in the obesity surgery clinic
Owen‐Smith, A., Coast, J., & Donovan, J. (2018) · Health Expectations · doi:10.1111/hex.12651 · Cited by 21
Priority setting in Indigenous health: assessing priority setting process and criteria that should guide the health system to improve Indigenous Australian health
Otim, M. E., Kelaher, M., Anderson, I. P. S., & Doran, C. M. (2014) · International Journal for Equity in Health · doi:10.1186/1475-9276-13-45 · Cited by 21
“An assessment of explicit priority setting attempted in several countries such as the United Kingdom, New Zealand and Sweden by Sabik and Lie yielded mixed results [28].”
Background
What Factors Do Allied Health Take Into Account When Making Resource Allocation Decisions?
Lane, H., Sturgess, T., Philip, K., Markham, D., Martin, J., Walsh, J., Hubbard, W., & Haines, T. P. (2017) · International Journal of Health Policy and Management · doi:10.15171/ijhpm.2017.105 · Cited by 20
The Humanistic and Economic Burden of Juvenile Idiopathic Arthritis in the era of Biologic Medication
Gidman, W. K., Meacock, R., & Symmons, D. P. M. (2015) · Current Rheumatology Reports · doi:10.1007/s11926-015-0508-1 · Cited by 19
“In a climate of finite healthcare budgets and scarce resources, decision-makers are increasingly using economic evaluations to guide resource allocation decisions [9, 14, 27].”
Background
Setting priorities in primary health care - on whose conditions? A questionnaire study
Arvidsson, E., André, M., Borgqúist, L., Andersson, D., & Carlsson, P. (2012) · BMC Family Practice · doi:10.1186/1471-2296-13-114 · Cited by 19
“Several countries with publicly financed health care systems use similar criteria [16,17].”
Background
Economic considerations on the usage of biologics in the allergy clinic
Azzano, P., Dufresne, É., Poder, T. G., & Bégin, P. (2020) · Allergy · doi:10.1111/all.14494 · Cited by 20
Health-care needs and shared decision-making in priority-setting
Gustavsson, E., & Sandman, L. (2014) · Medicine Health Care and Philosophy · doi:10.1007/s11019-014-9568-7 · Cited by 18
Indeterminacy and the principle of need
Herlitz, A. (2016) · Metamedicine · doi:10.1007/s11017-016-9393-5 · Cited by 18
Needs and cost-effectiveness in health care priority setting
Gustavsson, E., & Tinghög, G. (2020) · Health and Technology · doi:10.1007/s12553-020-00424-7 · Cited by 18
Comparative analysis of decision maker preferences for equity/efficiency attributes in reimbursement decisions in three European countries
Baji, P., García‐Goñi, M., Gulàcsi, L., Mentzakis, E., & Paolucci, F. (2015) · The European Journal of Health Economics · doi:10.1007/s10198-015-0721-x · Cited by 22
“Attributes, such as the potential number of beneficiaries, the severity of disease, the individual health benefit of the intervention are explicitly specified in some reimbursement regulations or recommendations [2,3].”
Background
The health systems' priority setting criteria for selecting health technologies: A systematic review of the current evidence.
Mobinizadeh, M., Raeissi, P., Nasiripour, A. A., Olyaeemanesh, A., & Tabibi, S. J. (2016) · PubMed Central · Cited by 18
Horizontal equity and mental health care: a study of priority ratings by clinicians and teams at outpatient clinics
Holman, P. A., Ruud, T., & Grepperud, S. (2012) · BMC Health Services Research · doi:10.1186/1472-6963-12-162 · Cited by 17
“Priority-setting is a complex and difficult challenge faced by decision-makers at all levels of a health care system, and a wide range of approaches and priority-setting guidelines are observed across various countries [2].”
Health inequality and governance in Scotland since 2007
Fox, D. M. (2013) · Public Health · doi:10.1016/j.puhe.2013.04.019 · Cited by 17
“Still others conduct cross-national comparisons of priority-setting processes or of spending to address various determinants of health, again without explicit attention to the effects of governance on policy.(15) This article, in contrast, seeks to answer questions about the governance of recent health policy in Scotl…”
Operationalization of Utilitarian and Egalitarian Objectives for Optimal Allocation of Health Care Resources
Hynninen, Y., Vilkkumaa, E., & Salo, A. A. (2020) · Decision Sciences · doi:10.1111/deci.12448 · Cited by 19
“…and programs is to reduce health inequalities, which has inspired much research on the equitable allocation of resources and the assessment of populationlevel equity considerations (see, e.g., Eddy, 1991; Emanuel, 2000; Beauchamp & Childress, 2001; Sabik & Lie, 2008; Hooker & Williams, 2012).”
Background
Using evaluation theory in priority setting and resource allocation
Smith, N., Mitton, C., Cornelissen, E., Gibson, J., & Peacock, S. J. (2012) · Journal of Health Organization and Management · doi:10.1108/14777261211256963 · Cited by 17
What explains ‘generosity’ in the public financing of high-tech drugs? An empirical investigation of 25 OECD countries and 11 controversial drugs
Böhm, K., Landwehr, C., & Steiner, N. D. (2014) · Journal of European Social Policy · doi:10.1177/0958928713511280 · Cited by 16
“A major European project has analyzed the content of health baskets in numerous countries (Schulenburg and Blanke 2004), and several studies have compared decision-making processes in smaller sets of countries (e.g. Ham and Robert 2003; Sabik and Lie 2008; Landwehr and Böhm 2011).”
Background
Understanding what matters: An exploratory study to investigate the views of the general public for priority setting criteria in health care
Ratcliffe, J., Lancsar, E., WALKER, R. B., & Gu, Y. (2017) · Health Policy · doi:10.1016/j.healthpol.2017.03.003 · Cited by 16
“challenged by the need to set priorities in the allocation of scarce public resources [1].”
Background
Public engagement in setting healthcare priorities: a ranking exercise in Cyprus
Farmakas, A., Θεοδώρου, Μ., Galanis, P., Karayiannis, G., Ghobrial, S., Polyzos, N. P., Papastavrou, E., Agapidaki, E., & Souliotis, K. N. (2017) · Cost Effectiveness and Resource Allocation · doi:10.1186/s12962-017-0078-3 · Cited by 16
Choosing health technology assessment and systematic review topics: The development of priority-setting criteria for patients’ and consumers’ interests
Bastian, H., Scheibler, F., Knelangen, M., Zschorlich, B., Nasser, M., & Waltering, A. (2011) · International Journal of Technology Assessment in Health Care · doi:10.1017/s0266462311000547 · Cited by 16
“The literature on priority setting in health does not explore the determinants of patient/consumer interest nor does it address the specific issue of priority setting for information provision (12;13;18).”
Background
Solidarity and cost management: Swiss citizens' reasons for priorities regarding health insurance coverage
Schindler, M., Danis, M., Goold, S. D., & Hurst, S. (2018) · Health Expectations · doi:10.1111/hex.12680 · Cited by 16
“Complete financial coverage (14) Alternative insurance argument (12) Another benefit is more important (9) Point argument (8) Lower level is justifiable (3) Redundancy (2) Financial reasons (170) Cost- benefit argument (70) Importance of financial protection (32) Adverse effect of health costs (18)”
Background
Supporting ageing well research: Findings from a research priority setting exercise
Doolan‐Noble, F., Mehta, P., Waters, D. L., & Baxter, D. G. (2019) · Australian Journal on Ageing · doi:10.1111/ajag.12615 · Cited by 15
How clinical rationing works in practice: A case study of morbid obesity surgery
Owen‐Smith, A., Donovan, J., & Coast, J. (2015) · Social Science & Medicine · doi:10.1016/j.socscimed.2015.11.008 · Cited by 15
Principles of Need and the Aggregation Thesis
Gustavsson, E., & Juth, N. (2017) · Health Care Analysis · doi:10.1007/s10728-017-0346-6 · Cited by 15
Priority setting in health care: Attitudes of physicians and patients
Winkelhage, J., Schreier, M., & Diederich, A. (2013) · Health · doi:10.4236/health.2013.54094 · Cited by 14
Value judgment of health interventions from different perspectives: arguments and criteria
Vermeulen, K. M., & Krabbe, P. F. M. (2018) · Cost Effectiveness and Resource Allocation · doi:10.1186/s12962-018-0099-6 · Cited by 15
“According to Golan [2], the key to evaluating the success of prioritization efforts lies in articulating appropriate principles as well as formulating reasons that are grounded in clear value choices [24].”
Background
An ethics analysis of the rationale for publicly funded plastic surgery
Sandman, L., & Hansson, E. (2020) · BMC Medical Ethics · doi:10.1186/s12910-020-00539-6 · Cited by 14

Authors: Sabik, L. M., & Lie, R. K.
Affiliations: National Institutes of Health (US)
Corresponding author: Lie, Reidar K
ORCID: Sabik, Lindsay M
Lie, Reidar K
Venue: International Journal for Equity in Health
Publisher: Springer Science and Business Media LLC
Published: 2008-01-21
Volume: 7
Issue: 1
Pages: 4-4
ISSN: 1475-9276 (ISSN-L)
DOI: 10.1186/1475-9276-7-4
PMC: PMC2248188
OpenAlex: W2077476869
Cited by: 312
References: 85
Citations by year: 2026: 7 · 2025: 8 · 2024: 13 · 2023: 11 · 2022: 13 · 2021: 14 · 2020: 17 · 2019: 37 · 2018: 18 · 2017: 20 · 2016: 16 · 2015: 21 · 2014: 19 · 2013: 23 · 2012: 21
FWCI: 40.84
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
www.springer.com/tdm (unspecified)
Locations: International Journal for Equity in Health (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders: U.S. Department of Health and Human Services
National Institutes of Health
NIH Clinical Center
Topics: Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Reforms
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Practices
Keywords: priority setting, healthcare resource allocation, health care justice, health care efficiency, value framework, public participation in health policy, comparative health policy, health care system

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Priority setting in health care: Lessons from the experiences of eight countries

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