January 23, 2020

How to distort priority setting?

Biases distorting priority setting

Why priority setting in health care has so poor outcomes while relevant systems are well developed and readily available? You just have to read this article to understand it.
It starts to identify some rational and structural explanations for the discrepancy between theoretical efforts and practical outcomes in priority setting. However, even if these issues are addressed, practical priority setting may still not obtain its goals. This is because a wide range of irrational effects is hampering priority setting: biases.

Table 1. Overview of various biases and potential implications for priority setting and at which level they may be most prominent.
BiasPotential ImplicationsLevel
Identifiability and Singularity effectUndermining principlesMicro
Rejection DislikeHamper disinvestmentMicro, meso
Failure Embarrassment effectOveruseMicro (primarily)
Prominence Effect (Opportunity Cost Neglect)Non-warranted useAll
Status Quo BiasOveruse, UnderuseAll
Endowment EffectOveruse, UnderuseMicro (primarily)
Loss AversionHamper disinvestmentAll
Aversion to Risk / AmbiguityOveruseMicro, meso
Availability HeuristicsOveruseMicro, meso
Sacred Values and Taboo trade-offsUndermining principlesAll
Progress biasOveruseAll
Adoption AddictionOveruseMicro, macro
Complexity biasUndermining principles, overuseMicro, meso, macro
Extension biasOveruseAll
Asymmetry of risks and benefitsOveruseMicro (primarily)
Positive cognitive feedback loopsUndermining principles, overuseMicro, meso, macro
Prestige biasUndermining principles, overuseMicro (primarily)
Imperative of ActionUndermining principles, overuseMicro (primarily)
Technology Placebo EffectUndermining principles, overuseMicro (primarily)
Imperative of KnowledgeOveruseMicro
Competency EffectOveruseMicro
Multiple ReplacementsOveruseMicro
White ElephantsOverinvestmentMicro
Boys and Toys EffectUnwarranted useMicro