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Priority setting in health care: Lessons from the experiences of eight countries
Open accessAbstract
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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“A wide range of approaches is taken and guidelines vary across different countries [16], illustrating that priority-setting is complex”
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“These criteria also provided guidance to the development of the guidelines for assessing the successes of the different priority setting frameworks that had been employed (Sabik & Lie, 2008).”
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“Priority setting in health-care services according to some pre-defined criteria is proposed as one possibility to handle the problem of limited resources and to provide a fair distribution of medical services (Sabik and Lie 2008 for a review).”
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“Yet, CDM may be informed by priority-setting efforts [10].”
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Nouri, S., Riahi, L., Hajinabi, K., & Jahangiri, K. (2018) · DOAJ (DOAJ: Directory of Open Access Journals) · Cited by 3
Deliberative Processes in Practice
Calyx, C., & Rowe, G. (2016) · The International library of ethics, law and technology · doi:10.1007/978-3-319-32240-7_5 · Cited by 3
Gustafsson, I., Winblad, U., Wallin, L., & Fredriksson, M. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-06815-4 · Cited by 3
“Background Healthcare systems around the world face major challenges in managing growing costs for healthcare services, and publicly financed healthcare systems, in particular, need to prioritise among the range of services that citizens expect to access [1].”
BackgroundTargeting Precision Medicine: Evidence from Prenatal Screening
Conner, P., Liran Einav, B., Finkelstein, A. N., Persson, P., & Williams, H. (2024) · Journal of Political Economy · doi:10.1086/732893 · Cited by 3
Law and medical practice: A comparative vignette survey of cardiologists in Norway and Denmark
Bjorvatn, A., Magnussen, A., & Wallander, L. (2020) · SAGE Open Medicine · doi:10.1177/2050312120946215 · Cited by 3
The current status of decision-making procedures and quality assurance in Europe: an overview
Valerio, L., & Ricciardi, W. (2011) · Medicine Health Care and Philosophy · doi:10.1007/s11019-011-9333-0 · Cited by 3
Omar, F., Tinghög, G., Tinghög, P., & Carlsson, P. (2009) · Scandinavian Journal of Public Health · doi:10.1177/1403494808100276 · Cited by 3
“The Swedish priority-setting principles are of such normative nature that they are difficult to oppose; this may have been partly responsible for the principles being drafted into law without serious controversy or disagreement [1,5].”
BackgroundFair Innings as a Basis for Prioritization: An Empirical Perspective
Watters, S. (2015) · Springer eBooks · doi:10.1007/978-3-319-21112-1_14 · Cited by 3
Thébaut, C., & Wittwer, J. (2017) · Revue française des affaires sociales · doi:10.3917/rfas.173.0169 · Cited by 3
A Scoring Index of Prioritization Factors Between Patients
Pinho, M. M., & Borges, A. P. (2019) · The Health Care Manager · doi:10.1097/hcm.0000000000000274 · Cited by 3
More than cost‐effectiveness? Applying a second‐stage filter to improve policy decision making
Kan, K., Jörg, F., Lokkerbol, J., Mihalopoulos, C., Buskens, E., Schoevers, R. A., & Feenstra, T. (2021) · Health Expectations · doi:10.1111/hex.13277 · Cited by 3
“Table 2 presents a summary of the findings for substitution pairs 1 and 2: investment in therapist- guided Internet- based cognitive behavioural treatment (iCBT) and disinvestment in individual cognitive behavioural therapy (CBT) for (1) mild and (2) moderate depression.”
BackgroundPrioritisation in healthcare—still muddling through
Gordijn, B., & ten Have, H. (2011) · Medicine Health Care and Philosophy · doi:10.1007/s11019-011-9322-3 · Cited by 3
“explicit prioritization? In their review of eight different national experiences with priorities setting since the late 1980s Sabik and Lie (2008) argue that little progress has been made.”
BackgroundWhat health care services does the public want and who should decide? Ask them!
Diederich, A. (2016) · Israel Journal of Health Policy Research · doi:10.1186/s13584-016-0107-2 · Cited by 3
“Sabik and Lie [9] review priority setting efforts in eight countries (Norway, Sweden, Israel, the Netherlands, Denmark, New Zealand, the United Kingdom, and the state of Oregon in the US).”
InfluentialMemirie, S. T., Argaw, M., Tolla, M. T., Abebe, F., Dagnaw, W. W., Norheim, O. F., & Yigezu, A. (2024) · International Journal for Equity in Health · doi:10.1186/s12939-024-02226-z · Cited by 2
“Besides, the public may not view prioritization of health care interventions based solely on cost-effectiveness as fair health care distribution [25].”
BackgroundPriority Setting in the Context of Planetary Healthcare
Apantaku, G. O., Kapiriri, L., Norheim, O. F., Azevedo, I. C. C., Kim, D., Hensher, M., Ananthapavan, J., Bhopal, A. S., MacNeill, A. J., Sherman, J. D., et al. (2025) · Applied Health Economics and Health Policy · doi:10.1007/s40258-025-00980-x · Cited by 3
“Priority setting, the process of making decisions on what to fund and not fund because of the reality of limited resources, is a core driver of the achievement of health system outcomes taking efficiency and fair distribution of benefits and burdens into account [1, 2].”
What should guide priority setting in health care? A study of public preferences in Sweden
Ryen, L., Jakobsson, N., & Svensson, M. (2019) · Nordic Journal of Health Economics · doi:10.5617/njhe.6159 · Cited by 2
“As people live longer and health care innovations offer a growing number of costly intervention options, there is a growing importance of priority setting, highlighting questions of fairness and efficiency (Sabik and Lie, 2008).”
Background
Metadata
- Authors
- Sabik, L. M., & Lie, R. K.
- Affiliations
- National Institutes of Health (US)
- Corresponding author
- Lie, Reidar K
- Venue
- International Journal for Equity in Health
- Published
- 2008-01-21
- Volume
- 7
- Issue
- 1
- Pages
- 4-4
- ISSN
- 1475-9276 (ISSN-L)
- 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
- 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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