January 31, 2015

The challenge of setting fair priorities

Public views on principles for health care priority setting: Findings of a European cross-country study using Q methodology

The clash between equity and efficiency is featured nowadays with hepatitis C drugs. High prices mean that access requires some kind of prioritisation. An interesting article may help to understand it:
 Resources available to the health care sector are finite and typically insufficient to fulfil all the demands for health care in the population. Decisions must be made about which treatments to provide. Relatively little is known about the views of the general public regarding the principles that should guide such decisions
The tension between equity and efficiency in the health care sector is apparent in a range of routine decisions and practices. For instance, in the prioritisation of patients on a waiting list, the aim to maximise overall health benefits from treatment may be at conflict with that of obtaining an equitable distribution of health and health care.
 Now ask yourself about the following principles to allocate health resources:
(I) “Egalitarianism, entitlement and equality of access”;
II) “Severity and the magnitude of health gains”;
(III) “Fair innings, young people and maximising health benefits”; 
(IV) “The intrinsic value of life and healthy living”; 
(V) “Quality of life is more important than simply staying alive”.
 Are you able to set a ranking? Does a general ranking of priorities always apply to all cases?. Not so easy. This is exactly what they do in the article and the results are:
Given the plurality of views on the principles for health care priority setting, no single equity principle can be used to underpin health care priority setting. Hence, the process of decision making becomes more important, in which, arguably, these multiple perspectives in society should be somehow reflected.
Let's think about the somehow...

PS. Sofosbuvir vs. NICE . And the winner is?