Resource Allocation and Priority Setting in Health Care: A Multi‐criteria Decision Analysis Problem of Value?
| Published date | 01 March 2017 |
| Date | 01 March 2017 |
| Author | Gilberto Montibeller,Panos Kanavos,Aris Angelis |
| DOI | http://doi.org/10.1111/1758-5899.12387 |
Resource Allocation and Priority Setting in
Health Care: A Multi-criteria Decision Analysis
Problem of Value?
Aris Angelis and Panos Kanavos
Medical Technology Research Group –LSE Health, London School of Economics,
London, United Kingdom
Gilberto Montibeller
Management Science and Operations Group, Loughborough University, Loughborough,
United Kingdom
Abstract
A methodological approach is needed for allocating health care resources in an efficient and fair way that gives legitimacy to
decisions. Currently, most priority setting approaches tend to focus on single or limited benefit dimensions, even though the
value of new health care interventions is multi-dimensional. Explicit elicitation of social value trade-offs is usually not possible
and decision-makers often adopt intuitive or heuristic modes for simplification purposes as part of an ad hoc decision-making
process which might diminish the reasonableness and credibility of the decisions. In this paper, we suggest that multi-criteria
decision analysis could provide a more comprehensive and transparent approach in health care to systematically capture deci-
sion-makers’concerns, compare value trade-offs and elicit their value preferences. We conclude that such methods could
inform the development of a decision support system in health care, contributing towards more efficient, rational and legiti-
mate resource allocation decisions.
1. Background
One of the foremost challenges health care systems are facing is
the scarcity of resources in combination with rising demand for
services, putting their sustainability in danger. As a result, deci-
sions relating to the allocation of health care resources have
been inevitable, either between different competing services
and interventions (i.e. priority setting) or across different patients
(i.e. rationing). However, the methodological approach of allo-
cating resources in an efficient and fair way that gives legitimacy
to decisions has been far from obvious (Beauchamp 2003; Eddy
1991a, 1991b; Emanuel 2000; Fleck 2001; Rawls,1999). This is in
large part due to: (1) the complexity of the decisions, as a variety
of different factors and objectives need to be balanced through
the involvement of a range of stakeholders; (2) the importance
of the decision outcomes, as they have a dramatic impact on
human health; and (3) the ethical and social responsibilities
behind the provision of health care which traditionally has been
perceived as a government duty, given that health is often
regarded as a public good or even a human right.
2. Resource allocation methods in the British
National Health Service
The British National Health Service (NHS) provides an
insightful case study of how priority setting in health care
evolved through the interplay of scientific advancements,
culture changes and politics. As a result, priority setting
today takes place across all levels of the organisational hier-
archy of the British health care system: the central govern-
ment sets the overall budget of the NHS, commissioners
and providers determine their purchases among alternative
services and interventions, and clinicians allocate their time
and resources (Klein and Maybin, 2012). Already by 1993 in
the UK, ‘micro-decisions about priority setting [were] con-
strained by macro-decisions about resource allocation taken
at superior levels in the organisational hierarchy’(Klein,
1993, p. 309), in an almost identical landscape where cabi-
net decided on the NHS budget, Department of Health
decided the priority targets, and purchasers decided on ser-
vices (Klein, 1993).
In general terms, in a multi-level context of priority set-
ting, rationing can be implemented in various ways: ration-
ing by deterrence, when obstacles to patient access are
imbedded; rationing by deflection, when the responsibility
of service provision is passed on to another agency; ration-
ing by dilution, when the quality of service declines; ration-
ing by denial, when a particular treatment is refused to get
funded; and rationing by selection, when a treatment is only
allowed for a particular population sub-group (Klein and
Maybin, 1993; Klein, 2010). In the UK, rationing by deter-
rence or delay was possibly the first of these models to
©2016 University of Durham and John Wiley & Sons, Ltd. Global Policy (2017) 8:Suppl.2 doi: 10.1111/1758-5899.12387
Global Policy Volume 8 . Supplement 2 . March 2017
76
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