About Priority Setting
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Priority setting concerns the decisions made about the allocation of resources when there are competing demands from different services, elements of care, or distinct patient groups. These decisions are tough. They force us to confront the challenging question: how are we to rank health services or patients against one another when each is of undeniable value and import?
Priority setting is a central pillar of health policy and decision-making. It happens at various levels within health care systems, each bringing with it a set of complex considerations. At the population level, decisions need to be made about which public health interventions to prioritise and how to equitably distribute health resources within the community. At the organisational level, health institutions must grapple with deciding which services to provide, and how to balance the demand for high-cost treatments against the need for basic care. Meanwhile, at the patient level, clinicians are often faced with the task of prioritising patients’ care needs when resources are limited. Deciding on a course of action can involve difficult trade-offs and can mean that some individuals or patient groups do not receive an essential service in a timely manner.
Methods for Setting Priorities
Various methods have been developed to help set priorities. These methods aim to facilitate the use of relevant data and theory to make allocation decisions in systematic, consistent, objective, and fair ways. For example, cost-effectiveness analysis is used in many health care systems to inform decisions about which medicines to pay for. Triage systems are used in emergency rooms and disaster situations to make decisions about which casualties to treat first. Different methods incorporate different values that might be thought relevant to priority setting. These include principles like directing resources where they can yield the most health benefit per unit of cost, but also considerations of equity, need, accessibility, and social value. Priority setting, as an integral part of healthcare decision-making, must try to balance these different values while still providing actionable recommendations. It is, therefore, vital to approach this task with a deep sense of responsibility, grounded in ethical principles, and informed by the best available evidence.
The ISPH resources pages and briefing notes provide citations to literature that delves deeper into the multifaceted and complex world of priority setting in health. These resources aim to shed light on the intricate dynamics of health care systems, the ethical considerations that ought to play a role, and practical applications of priority setting methods.
Author: Joseph Millum