Criteria for fairly allocating scarce health-care resources to genetic tests: which matter most?

Rogowski, W.; Grosse, Scott D.; Schmidtke, Jörg; Marckmann, Georg

doi:10.1038/ejhg.2013.172

Cited by 25 publications

(30 citation statements)

References 49 publications

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“…Given that need is a key criterion for allocating scarce health care resources also in genetics [49], it used an inductive approach to needs assessment, starting with specific types of medical need relevant for genetics. This provides a condition-specific alternative to the more general specification of an aim of health care (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…To develop such a framework, this study uses literature searches described elsewhere [5] and discussions during a consensus process on prioritizing genetic tests [18].…”

Section: Methodsmentioning

confidence: 99%

“…A rapidly expanding number of new genetic tests is available and used in health care for personalized specific reactions to medical treatments) to a defined clinical context [5]. The prioritization thus does not relate solely to tests but to groups of patients in specific clinical situation described as the test attributes below.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, the project also included an assessment of prioritization criteria acceptable for genetic tests. Even if most economic frameworks are based on welfarist maximization of individual benefit or on extra-welfarist maximization of health outcomes, neither of these is likely to be widely accepted by decision makers and stakeholders of genetic services [5].…”

Section: Introductionmentioning

confidence: 99%

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Using needs-based frameworks for evaluating new technologies: An application to genetic tests

Rogowski¹,

Schleidgen²

2015

Health Policy

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Given the multitude of newly available genetic tests in the face of limited healthcare budgets, the European Society of Human Genetics assessed how genetic services can be prioritized fairly. Using (health) benefit maximizing frameworks for this purpose has been criticized on the grounds that rather than maximization, fairness requires meeting claims (e.g. based on medical need) equitably. This study develops a prioritization score for genetic tests to facilitate equitable allocation based on need-based claims. It includes attributes representing health need associated with hereditary conditions (severity and progression), a genetic service's suitability to alleviate need (evidence of benefit and likelihood of positive result) and costs to meet the needs. A case study for measuring the attributes is provided and a suggestion is made how need-based claims can be quantified in a priority function. Attribute weights can be informed by data from discrete-choice experiments. Further work is needed to measure the attributes across the multitude of genetic tests and to determine appropriate weights. The priority score is most likely to be considered acceptable if developed within a decision process which meets criteria of procedural fairness and if the priority score is interpreted as "strength of recommendation" rather than a fixed cut-off value.

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Section: Discussionmentioning

confidence: 99%

“…To develop such a framework, this study uses literature searches described elsewhere [5] and discussions during a consensus process on prioritizing genetic tests [18].…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Using needs-based frameworks for evaluating new technologies: An application to genetic tests

Rogowski¹,

Schleidgen²

2015

Health Policy

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“…The allocation of scarce resources in healthcare has received considerable interest in the academic world. Optimizing resource use or reducing the demand for particular resources [30] and choosing which patients receive particular resources according to guidelines [31] or according to the patient's degree of need [32] are all solutions proposed to this issue.…”

Section: Resources Related To Specific Patient Needsmentioning

confidence: 99%

Emergency boarding: An integrative framework for analyzing causes and seeking solutions

Limoges

Gemmel

Landry

et al. 2017

JHA

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Background: One of the root causes of crowding at the Emergency Department (ED) is boarding, i.e. the practice of holding admitted patients in the ED until an inpatient (IP) bed becomes available. Although ED boarding has been approached by various authors, few of them have aimed to see how different hospitals perform in regard to this issue. Objective: This study will approach ED boarding from different angles, analyzing both quantitative and qualitative data, and following both deductive and inductive reasoning. The purpose is to develop a validated integrative conceptual framework which can be used to analyze ED boarding, and to look for solutions. Methods: The development of the framework is based on an extensive literature review and a multiple case study research with both qualitative and quantitative data collection. Results: ED boarding was found to be prominent in the studied hospitals. Four root causes of ED boarding were elucidated, which are: (1) uncoordinated admissions and discharges, (2) late discharges, (3) the inability to discharge patients, and (4) a lack of communication, collaboration, and information between the different actors of the patient care process. Many solutions are proposed to improve these issues. Conclusions: Through the analysis of various types of data, an integrative conceptual framework for ED boarding was elaborated for analyzing causes and seeking solutions. The quantative data cannot only be used in the analysis stage, but can also help in designing a solution as there are clear recognizable trends in arrival, discharge and ED boarding time. "Communication, collaboration and information", although not explicitly discussed in the literature, was found to be the most prominent cause and solution to ED boarding in the field study. Practice implications: Management practitioners now have a framework demonstrating probable causes for ED boarding, which provides a starting point for analysis within their establishments. Pathways to improvement are suggested as well, which will help managers to reduce ED boarding. Communication, collaboration and information are important in these improvement efforts.

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Canadian genetic healthcare professionals’ attitudes towards discussing private pay options with patients

Gioacchino

Langlois

Elliott

2019

Molec Gen & Gen Med

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Background Just as there is inconsistency with respect to coverage of genomic testing with insurance carriers, there is interprovincial discrepancy in Canada. Consequently, the option of private pay (e.g., self pay) arises, which can lead to inequities in access, particularly when patients may not be aware of this option. There are currently no published data regarding how the Canadian genetics community handles discussions of private pay options with patients. The purpose of this study was to assess the attitudes of genetic healthcare professionals (GHPs: medical geneticists, genetic counselors, and genetic nurses) practicing in Canada toward these discussions. Methods An online survey was distributed to members of the Canadian College of Medical Geneticists and the Canadian Association of Genetic Counsellors to assess frequencies, rationale, and ethical considerations regarding these conversations. Quantitative data were analyzed using descriptive statistics. Results Of 144 respondents, 95% reported discussing private pay and 65% reported working in a clinic without a policy on this issue. There were geographic and practice‐specific differences. The most common circumstance for these discussions was when a test was clinically indicated (e.g., but funding was denied) followed by when the patient initiated the conversation. The most frequently discussed tests included: multi‐gene panels (73% of respondents), noninvasive prenatal testing (62%), and pre‐implantation genetic diagnosis (58%). Although 65% felt it was ethical to discuss private pay, 35% indicated it was “sometimes” ethical. Conclusion With the increasing availability of genomic technologies, these findings inform how we practice and demonstrate the need for policy in this area.

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Criteria for fairly allocating scarce health-care resources to genetic tests: which matter most?

Cited by 25 publications

References 49 publications

Using needs-based frameworks for evaluating new technologies: An application to genetic tests

Using needs-based frameworks for evaluating new technologies: An application to genetic tests

Emergency boarding: An integrative framework for analyzing causes and seeking solutions

Canadian genetic healthcare professionals’ attitudes towards discussing private pay options with patients

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