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Published in: Health Care Analysis 2/2008

01-06-2008 | Original Article

An Ethical Analysis of International Health Priority-Setting

Authors: Nuala Kenny, Christine Joffres

Published in: Health Care Analysis | Issue 2/2008

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Abstract

Health care systems throughout the developed world face ‘crises’ of quality, financing and sustainability. These pressures have led governments to look for more efficient and equitable ways to allocate public resources. Prioritisation of health care services for public funding has been one of the strategies used by decision makers to reconcile growing health care demands with limited resources. Priority setting at the macro level has yet to demonstrate real successes. This paper describes international approaches to explicit prioritisation at the macro-governmental level in the six experiences most published in the English literature; analyzes the ways in which values, principles and other normative concepts were presented in these international priority setting experiences; and identifies key elements of a more robust framework for ethical analysis which could promote meaningful and effective health priority setting.
Literature
1.
go back to reference Arnesen, T. M., & Norheim, O. F. (2003). Quantifying quality of life for economic analysis: Time out for time trade-off. Medical Humanities, 29(2), 81–86.PubMedCrossRef Arnesen, T. M., & Norheim, O. F. (2003). Quantifying quality of life for economic analysis: Time out for time trade-off. Medical Humanities, 29(2), 81–86.PubMedCrossRef
2.
go back to reference Bäckman, K., Anderson, A., & Carlsson, P. (2004). Open priorities in Östergötland, part I. The political decision making process (Vol. 4). National centre for priority setting in health care. English Version of 2004. Bäckman, K., Anderson, A., & Carlsson, P. (2004). Open priorities in Östergötland, part I. The political decision making process (Vol. 4). National centre for priority setting in health care. English Version of 2004.
3.
go back to reference Bernfort, L. (2003). Decisions on inclusion in the Swedish basic health care package-roles of cost-effectiveness and need. Health Care Analysis, 11(4), 301–308. Bernfort, L. (2003). Decisions on inclusion in the Swedish basic health care package-roles of cost-effectiveness and need. Health Care Analysis, 11(4), 301–308.
4.
go back to reference Biller-Andorno, N., Lie, R. K., & ter Meulen, R. (2002). Evidence-based medicine as an instrument for rational health policy. Health Care Analysis, 10(3), 261–275.PubMedCrossRef Biller-Andorno, N., Lie, R. K., & ter Meulen, R. (2002). Evidence-based medicine as an instrument for rational health policy. Health Care Analysis, 10(3), 261–275.PubMedCrossRef
5.
go back to reference Brown, L. D. (1991). The national politics of Oregon’s rationing plan. Health Affairs, 10(2), 28–51.PubMedCrossRef Brown, L. D. (1991). The national politics of Oregon’s rationing plan. Health Affairs, 10(2), 28–51.PubMedCrossRef
6.
go back to reference Calltorp, J. (1999). Priority-setting in health policy in Sweden and a comparison with Norway. Health Policy, 50(1–2), 1–22.PubMedCrossRef Calltorp, J. (1999). Priority-setting in health policy in Sweden and a comparison with Norway. Health Policy, 50(1–2), 1–22.PubMedCrossRef
7.
go back to reference Coast, J. (1996). The Oregon Plan: Technical priority setting in the USA. In Priority setting; The health care debate, ed John Wiley & Sons, (pp. 113–139). Chichester, UK: Wiley. Coast, J. (1996). The Oregon Plan: Technical priority setting in the USA. In Priority setting; The health care debate, ed John Wiley & Sons, (pp. 113–139). Chichester, UK: Wiley.
8.
go back to reference Coast, J., Donovan, J., & Frankel, S. (1996). Priority setting: The health care debate. New York: John Wiley & Sons. Coast, J., Donovan, J., & Frankel, S. (1996). Priority setting: The health care debate. New York: John Wiley & Sons.
9.
go back to reference Coulter, A., & Ham, C. (2000). The global challenge of health care rationing. Philadelphia: Open University Press. Coulter, A., & Ham, C. (2000). The global challenge of health care rationing. Philadelphia: Open University Press.
10.
go back to reference Cumming, J. (1997). Defining core services: New Zealand experiences. Journal of Health Services Research & Policy, 2(1), 31–37. Cumming, J. (1997). Defining core services: New Zealand experiences. Journal of Health Services Research & Policy, 2(1), 31–37.
11.
go back to reference Daniels, N. (2000). Accountability for reasonableness. British Medical Journal, 321(7272), 1300–1302.PubMedCrossRef Daniels, N. (2000). Accountability for reasonableness. British Medical Journal, 321(7272), 1300–1302.PubMedCrossRef
12.
go back to reference Daniels, N., & Sabin, J. E. (2002). Setting limits fairly: Can we learn to share medical resources. New York: Oxford University Press. Daniels, N., & Sabin, J. E. (2002). Setting limits fairly: Can we learn to share medical resources. New York: Oxford University Press.
13.
go back to reference Danis, M., Clancy, C., & Churchill, L. R. (2002). Ethical dimensions of health policy. New York: Oxford University Press. Danis, M., Clancy, C., & Churchill, L. R. (2002). Ethical dimensions of health policy. New York: Oxford University Press.
14.
go back to reference Danish Council of Ethics. (1997). Priority-setting in the health service (Vol. 5). Danish Council of Ethics. Danish Council of Ethics. (1997). Priority-setting in the health service (Vol. 5). Danish Council of Ethics.
15.
go back to reference Dictionary. (2007). Priority. http://dictionary.reference.com Dictionary. (2007). Priority. http://​dictionary.​reference.​com
16.
go back to reference Dobrow, M. J., Goel, V., & Upshur, R. E. G. (2004). Evidence-based health policy: Context and utilisation. Social Science & Medicine, 58(1), 207–217.CrossRef Dobrow, M. J., Goel, V., & Upshur, R. E. G. (2004). Evidence-based health policy: Context and utilisation. Social Science & Medicine, 58(1), 207–217.CrossRef
17.
go back to reference Edgar, W. (2000). Rationing health care in New Zealand–how the public has a say. In C. Ham & A. Coulter (Eds.), The global challenge of health care rationing (pp. 175–191). Buckingham: Open University Press. Edgar, W. (2000). Rationing health care in New Zealand–how the public has a say. In C. Ham & A. Coulter (Eds.), The global challenge of health care rationing (pp. 175–191). Buckingham: Open University Press.
18.
go back to reference Ellis, R. D. (1998). Why there is no “Incommensurable Pluralism” of value systems. In Just Results: Ethical Foundations for Policy Analysis, (pp. 33–56). Washington DC: Georgetown University Press. Ellis, R. D. (1998). Why there is no “Incommensurable Pluralism” of value systems. In Just Results: Ethical Foundations for Policy Analysis, (pp. 33–56). Washington DC: Georgetown University Press.
19.
go back to reference Giacomini Mita, K. (1999). The Which-hunt: Assembling health technologies for assessment and rationing. Journal of Health Politics, 24(4), 715–758. Giacomini Mita, K. (1999). The Which-hunt: Assembling health technologies for assessment and rationing. Journal of Health Politics, 24(4), 715–758.
20.
go back to reference Hadorn, D. (1996). The Oregon priority-setting exercise: Cost-effectiveness and the rule of rescue, revisited. Medical Decision Making, 16(2), 117–119.PubMedCrossRef Hadorn, D. (1996). The Oregon priority-setting exercise: Cost-effectiveness and the rule of rescue, revisited. Medical Decision Making, 16(2), 117–119.PubMedCrossRef
21.
go back to reference Ham, C. (1997). Priority setting in health care: Learning from international experience. Health Policy, 42(1), 49–66.PubMedCrossRef Ham, C. (1997). Priority setting in health care: Learning from international experience. Health Policy, 42(1), 49–66.PubMedCrossRef
22.
go back to reference Ham, C., & Coulter, A. (2001). Explicit and implicit rationing: Taking responsibility and avoiding blame for health care choices. Journal of Health Services Research and Policy, 6, 163–169.PubMedCrossRef Ham, C., & Coulter, A. (2001). Explicit and implicit rationing: Taking responsibility and avoiding blame for health care choices. Journal of Health Services Research and Policy, 6, 163–169.PubMedCrossRef
23.
go back to reference Hanson, M. J., & Callahan, D. (1999). The goals of medicine: The forgotten issues in health care reform. Georgetown: Georgetown University Press. Hanson, M. J., & Callahan, D. (1999). The goals of medicine: The forgotten issues in health care reform. Georgetown: Georgetown University Press.
24.
go back to reference Hayry, M. (2003). European values in bioethics: Why, what, and how to be used? Theoretical Medicine, 24, 199–214.CrossRef Hayry, M. (2003). European values in bioethics: Why, what, and how to be used? Theoretical Medicine, 24, 199–214.CrossRef
25.
go back to reference Hermans, H., & den Exter, A. (1998). Priorities and priority-setting in health care. Croatian Medical Journal, 39(3), 346–355.PubMed Hermans, H., & den Exter, A. (1998). Priorities and priority-setting in health care. Croatian Medical Journal, 39(3), 346–355.PubMed
26.
go back to reference Hoedemaekers, R. (2003). Introduction: Towards better integration of normative judgements in health care package decisions. Health Care Analysis, 11(4), 275–278.PubMedCrossRef Hoedemaekers, R. (2003). Introduction: Towards better integration of normative judgements in health care package decisions. Health Care Analysis, 11(4), 275–278.PubMedCrossRef
27.
go back to reference Hoedemaekers, R., & Dekkers, W. (2003a). Justice and solidarity in priority setting in health care. Health Care Analysis, 11(4), 325–343.PubMedCrossRef Hoedemaekers, R., & Dekkers, W. (2003a). Justice and solidarity in priority setting in health care. Health Care Analysis, 11(4), 325–343.PubMedCrossRef
28.
go back to reference Hoedemaekers, R., & Dekkers, W. (2003b). Key concepts in health care priority setting. Health Care Analysis, 11(4), 309–323.PubMedCrossRef Hoedemaekers, R., & Dekkers, W. (2003b). Key concepts in health care priority setting. Health Care Analysis, 11(4), 309–323.PubMedCrossRef
29.
go back to reference Hoedemaekers, R., & Oortwijn, W. (2003). Problematic notions in Dutch health care package decisions. Health Care Analysis, 11(4), 287–294.PubMedCrossRef Hoedemaekers, R., & Oortwijn, W. (2003). Problematic notions in Dutch health care package decisions. Health Care Analysis, 11(4), 287–294.PubMedCrossRef
30.
go back to reference Honigsbaum, F., Calltorp, J., Ham, C., & Holmstrom, S. (1995). Priority setting processes for health care in Oregon, USA; New Zealand; The Netherlands; Sweden; and the United Kingdom. New York: Radcliffe Medical Press. Honigsbaum, F., Calltorp, J., Ham, C., & Holmstrom, S. (1995). Priority setting processes for health care in Oregon, USA; New Zealand; The Netherlands; Sweden; and the United Kingdom. New York: Radcliffe Medical Press.
31.
go back to reference Houtepen, R., & ter Meulen, R. T. (2000a). The expectation(s) of solidarity: Matters of justice, responsibility and identity in the reconstruction of the health care system. Health Care Analysis, 8(4), 355–376.PubMedCrossRef Houtepen, R., & ter Meulen, R. T. (2000a). The expectation(s) of solidarity: Matters of justice, responsibility and identity in the reconstruction of the health care system. Health Care Analysis, 8(4), 355–376.PubMedCrossRef
32.
go back to reference Houtepen, R., & ter Meulen, R. T. (2000b). New types of solidarity in the European welfare state. Health Care Analysis , 8(4), 329–340.PubMedCrossRef Houtepen, R., & ter Meulen, R. T. (2000b). New types of solidarity in the European welfare state. Health Care Analysis , 8(4), 329–340.PubMedCrossRef
33.
go back to reference Hunter, D. J. (1997). Measuring the appropriateness of hospital use. Canadian Medical Association Journal, 157(7), 901–902.PubMed Hunter, D. J. (1997). Measuring the appropriateness of hospital use. Canadian Medical Association Journal, 157(7), 901–902.PubMed
34.
go back to reference Hurley, J., Crosby, J. L., Giacomimi, M., & Hutchson, B. (2000). Making resource allocation decisions in the health care sector: A review of some recent proposals. Saskatoon, Saskachewan: Regionalization Research Centre, Ooccasional Paper. Hurley, J., Crosby, J. L., Giacomimi, M., & Hutchson, B. (2000). Making resource allocation decisions in the health care sector: A review of some recent proposals. Saskatoon, Saskachewan: Regionalization Research Centre, Ooccasional Paper.
35.
go back to reference Kapiriri, L., & Martin, D. K. (2007). Bedside rationing by health practitioners: A case study in a Ugandan hospital. Medical Decision Making, 27(1), 44–52.PubMedCrossRef Kapiriri, L., & Martin, D. K. (2007). Bedside rationing by health practitioners: A case study in a Ugandan hospital. Medical Decision Making, 27(1), 44–52.PubMedCrossRef
36.
go back to reference Kenny, N. P., & Giacomini, M. (2005). Wanted: A new ethics field for health policy analysis. Health Care Analysis, 13(4), 247–260.PubMedCrossRef Kenny, N. P., & Giacomini, M. (2005). Wanted: A new ethics field for health policy analysis. Health Care Analysis, 13(4), 247–260.PubMedCrossRef
37.
go back to reference Kluge, E. H., & Tomasson, K. (2002). Health care resource allocation: Complicating ethical factors at the macro-allocation level. Health Care Analysis, 10(2), 209–220.PubMedCrossRef Kluge, E. H., & Tomasson, K. (2002). Health care resource allocation: Complicating ethical factors at the macro-allocation level. Health Care Analysis, 10(2), 209–220.PubMedCrossRef
38.
go back to reference Liss, P. E. (2003). The significance of the goal of health care for the setting of priorities. Health Care Analysis, 11(2), 161–169.PubMedCrossRef Liss, P. E. (2003). The significance of the goal of health care for the setting of priorities. Health Care Analysis, 11(2), 161–169.PubMedCrossRef
39.
go back to reference Litva, A., Coast, J., Donovan, J., Eyles, J., Shepherd, M., Tacchi, J., Abelson, J., & Morgan, K. (2002). The public is too subjective: Public involvement at different levels of health-care decision making. Social Science & Medicine, 54(12), 1825–1837.CrossRef Litva, A., Coast, J., Donovan, J., Eyles, J., Shepherd, M., Tacchi, J., Abelson, J., & Morgan, K. (2002). The public is too subjective: Public involvement at different levels of health-care decision making. Social Science & Medicine, 54(12), 1825–1837.CrossRef
40.
go back to reference Martin, D., & Singer, P. (2003). A strategy to improve priority setting in health care institutions. Health Care Analysis, 11(1), 59–68.PubMedCrossRef Martin, D., & Singer, P. (2003). A strategy to improve priority setting in health care institutions. Health Care Analysis, 11(1), 59–68.PubMedCrossRef
41.
go back to reference Mechanic, D. (1997). Muddling through elegantly: Finding the proper balance in rationing–explicit rationing at the clinical level is likely to cause more harm than good. Health Affairs, 16(5), 83–92.PubMedCrossRef Mechanic, D. (1997). Muddling through elegantly: Finding the proper balance in rationing–explicit rationing at the clinical level is likely to cause more harm than good. Health Affairs, 16(5), 83–92.PubMedCrossRef
42.
go back to reference Ministry of Health. (1991). Your health and the public health; A statement of government health policy. (Vol. 3). Wellington, N.Z: Ministry of Health. Ministry of Health. (1991). Your health and the public health; A statement of government health policy. (Vol. 3). Wellington, N.Z: Ministry of Health.
43.
go back to reference Ministry of Welfare HaCA. (1992). Choices in health care. ed The Government committee on choices in health care. (Vol. 45). The Netherlands. Ministry of Welfare HaCA. (1992). Choices in health care. ed The Government committee on choices in health care. (Vol. 45). The Netherlands.
44.
go back to reference Mullen, P. M. (2000). Public involvement in health care priority setting: Are the methods appropriate and valid? In A. Coulter & C. Ham (Eds.), The global challenge of health care rationing (pp. 163–174). Buckingham: Open Universuty Press. Mullen, P. M. (2000). Public involvement in health care priority setting: Are the methods appropriate and valid? In A. Coulter & C. Ham (Eds.), The global challenge of health care rationing (pp. 163–174). Buckingham: Open Universuty Press.
45.
go back to reference Nordenfelt, L. (2001). On the goals of medicine, health enhancement and social welfare. Health Care Analysis, 9(1), 15–23.PubMedCrossRef Nordenfelt, L. (2001). On the goals of medicine, health enhancement and social welfare. Health Care Analysis, 9(1), 15–23.PubMedCrossRef
46.
go back to reference Norheim, O. F. (2002a). The role of evidence in health policy making: A normative perspective. Health Care Analysis, 10(3), 309–317.PubMedCrossRef Norheim, O. F. (2002a). The role of evidence in health policy making: A normative perspective. Health Care Analysis, 10(3), 309–317.PubMedCrossRef
47.
go back to reference Norheim, O. (2002b). Role of evidence in health policy making: A normative perspective. Health Care Analysis, 10, 309–317.PubMedCrossRef Norheim, O. (2002b). Role of evidence in health policy making: A normative perspective. Health Care Analysis, 10, 309–317.PubMedCrossRef
48.
go back to reference Norheim, O. F. (2005). Rights to specialized care in Norway: A normative perspective. Journal of Law, Medicine and Ethics, 2(winter), 10. Norheim, O. F. (2005). Rights to specialized care in Norway: A normative perspective. Journal of Law, Medicine and Ethics, 2(winter), 10.
49.
go back to reference Norheim, O. F., Ekeberg, O., Evensen, S. A., Halvorsen, M., & Kvernebo, K. (2001). Adoption of new health care services in Norway (1993–1997): Specialists’ self-assessment according to national criteria for priority setting. Health Policy, 56(1), 65–79.PubMedCrossRef Norheim, O. F., Ekeberg, O., Evensen, S. A., Halvorsen, M., & Kvernebo, K. (2001). Adoption of new health care services in Norway (1993–1997): Specialists’ self-assessment according to national criteria for priority setting. Health Policy, 56(1), 65–79.PubMedCrossRef
50.
go back to reference Reeleder, D., Goel, V., Singer, P. A., & Martin, D. K. (2006). Leadership and priority setting: The perspective of hospital CEOs. Health Policy, 79(1), 24–34.PubMedCrossRef Reeleder, D., Goel, V., Singer, P. A., & Martin, D. K. (2006). Leadership and priority setting: The perspective of hospital CEOs. Health Policy, 79(1), 24–34.PubMedCrossRef
51.
go back to reference Robinson, R. (1999). Limits to rationality: Economics, economists and priority setting. Health Policy, 49(1–2), 13–26.PubMedCrossRef Robinson, R. (1999). Limits to rationality: Economics, economists and priority setting. Health Policy, 49(1–2), 13–26.PubMedCrossRef
52.
go back to reference Sulmasy, D. P. (1992). Physicians, cost control, and ethics. Annals of Internal Medicine, 116(11), 920–926.PubMed Sulmasy, D. P. (1992). Physicians, cost control, and ethics. Annals of Internal Medicine, 116(11), 920–926.PubMed
53.
go back to reference Tenbensel, T. (2004). Does more evidence lead to better policy? The implications of explicit priority setting in New Zealand’s Health Policy for evidence-based policy, (pp. 189–207). Carfax publishing. Tenbensel, T. (2004). Does more evidence lead to better policy? The implications of explicit priority setting in New Zealand’s Health Policy for evidence-based policy, (pp. 189–207). Carfax publishing.
54.
go back to reference Tengs, T. O., Meyer, G., Siegel, J. E., Pliskin, J. S., Graham, J. D., & Weinstein, M. C. (1996). Oregon’s medicaid ranking and cost-effectiveness: Is there any relationship? Medical Decision Making, 16(2), 99–107.PubMedCrossRef Tengs, T. O., Meyer, G., Siegel, J. E., Pliskin, J. S., Graham, J. D., & Weinstein, M. C. (1996). Oregon’s medicaid ranking and cost-effectiveness: Is there any relationship? Medical Decision Making, 16(2), 99–107.PubMedCrossRef
55.
go back to reference The Health Care, & Medical Priorities Commission. (1993). No easy choices: The difficult pririties of health care. Stockholm: The Ministry of Health & Social Care. The Health Care, & Medical Priorities Commission. (1993). No easy choices: The difficult pririties of health care. Stockholm: The Ministry of Health & Social Care.
56.
go back to reference The Swedish Parliamentary Priorities Commission. (1995). Priorities in health care: Ethics, economy, implementation. (Vol. 26). Stockholm: The Ministry of Health and Social Affairs. The Swedish Parliamentary Priorities Commission. (1995). Priorities in health care: Ethics, economy, implementation. (Vol. 26). Stockholm: The Ministry of Health and Social Affairs.
57.
go back to reference Tymstra, T., & Andela, M. (1993). Opinions of Dutch physicians, nurses, and citizens on health-care policy, rationing, and technology. Jama-Journal of the American Medical Association, 270(24), 2995–2999.CrossRef Tymstra, T., & Andela, M. (1993). Opinions of Dutch physicians, nurses, and citizens on health-care policy, rationing, and technology. Jama-Journal of the American Medical Association, 270(24), 2995–2999.CrossRef
58.
go back to reference van der Grinten, T. E., & Kasdorp, J. P. (1999). Choices in Dutch health care: Mixing strategies and responsibilities. Health Policy, 50(1–2), 105–122.PubMedCrossRef van der Grinten, T. E., & Kasdorp, J. P. (1999). Choices in Dutch health care: Mixing strategies and responsibilities. Health Policy, 50(1–2), 105–122.PubMedCrossRef
59.
go back to reference van Willigenburg, T. (1993). Communitarian illusions: Or why the Dutch proposal for setting priorities in health care must fail. Health Care Analysis, 1(1), 49–52.PubMedCrossRef van Willigenburg, T. (1993). Communitarian illusions: Or why the Dutch proposal for setting priorities in health care must fail. Health Care Analysis, 1(1), 49–52.PubMedCrossRef
60.
go back to reference Walton, N. A., Martin, D. K., Peter, E. H., Pringle, D. M., & Singer, P. A. (2007). Priority setting and cardiac surgery: A qualitative case study. Health Policy, 80(3), 444–458.PubMedCrossRef Walton, N. A., Martin, D. K., Peter, E. H., Pringle, D. M., & Singer, P. A. (2007). Priority setting and cardiac surgery: A qualitative case study. Health Policy, 80(3), 444–458.PubMedCrossRef
Metadata
Title
An Ethical Analysis of International Health Priority-Setting
Authors
Nuala Kenny
Christine Joffres
Publication date
01-06-2008
Publisher
Springer US
Published in
Health Care Analysis / Issue 2/2008
Print ISSN: 1065-3058
Electronic ISSN: 1573-3394
DOI
https://doi.org/10.1007/s10728-007-0065-5

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