Ethics and economics: does programme budgeting and marginal analysis contribute to fair priority setting?

Gibson, Jennifer L.; Mitton, Craig; Martin, Douglas K.; Donaldson, Cam; Сингер, Петер

doi:10.1258/135581906775094280

Cited by 57 publications

(67 citation statements)

References 14 publications

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“…use of the formal priority setting approach known as PBmA has been shown in other contexts to make decision-makers more aware of the ethical issues involved in allocating scarce resources (e.g., see Gibson et al 2006). In some cases, as shown in our findings, this awareness may lead to moral distress.…”

Section: Discussionmentioning

confidence: 61%

Moral Distress among Healthcare Managers: Conditions, Consequences and Potential Responses

Mitton

Peacock²,

Storch³

et al. 2010

hcpol

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moral distress -the physical and emotional response to feeling prevented from carrying out ethically proper action -can have serious consequences for health professionals and healthcare organizations. We investigated perceived moral distress qualitatively with managers in two BC health authorities. Respondents described conditions under which they experienced distress: when they set priorities within highly resource-constrained environments, when they observed inequities between budget allocations and management responsibilities, and when organizational priorities did not align with their personal values. When coping proved insufficient, managers would respond by leaving positions, organizations or the healthcare field altogether. Respondents asked for leadership development and the creation of spaces in which moral distress could be openly discussed. However, formal training in priority setting did not appear to be helpful on its own. Rather, it increased managers' awareness of the ethical dimensions of resource allocation without (in this instance) entrenching supports that would help them resolve these concerns. RésuméLa souffrance morale -réaction physique et émotionnelle liée au fait de se sentir incapable d' accomplir éthiquement une action -peut avoir de sérieuses conséquences pour les professionnels de la santé et les organismes de soins de santé. Nous avons étudié la perception qualitative de la souffrance morale chez les gestionnaires de deux autorités sanitaires en Colombie-Britannique. Les répondants ont décrit les conditions dans lesquelles ils éprouvent de la souffrance : quand ils établissent des priorités dans un contexte où les ressources sont très restreintes, quand ils observent des iniquités entre l' engagement des dépenses et les responsabilités de gestion et quand les priorités organisationnelles ne concordent pas avec leurs valeurs personnelles. s'ils se sentent incapables de faire face à la situation, les

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Section: Discussionmentioning

confidence: 61%

Moral Distress among Healthcare Managers: Conditions, Consequences and Potential Responses

Mitton

Peacock²,

Storch³

et al. 2010

hcpol

Self Cite

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“…The use of evidence in priority setting was more prominent in the HICs ( Gibson et al ., 2006; Goodwin & Frew, 2013; Menon et al ., 2007; Robinson et al ., 2012) than the LMICs. This was because priority setting in LMICs was characterized by historical allocations and subjective considerations ( Table 3).…”

Section: Resultsmentioning

confidence: 99%

“…Majority of the papers attributed the failure to meet this condition to constant failure by decision makers to provide rationale for decisions made ( Bravo Vergel & Ferguson, 2006; Bukachi et al ., 2014; Gibson et al ., 2006; Maluka et al ., 2010a; Zulu et al ., 2014). For example, Bravo Vergel & Ferguson (2006), observed that though the primary care trusts in England made some effort to communicate priority setting policies through general practitioners and in some few instances through flowcharts and leaflets, the provision of rationale for the decisions were never given.…”

Section: Resultsmentioning

confidence: 99%

Evaluating healthcare priority setting at the meso level: A thematic review of empirical literature

Waithaka¹,

Tsofa²,

Barasa³

2018

Wellcome Open Res

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Background: Decentralization of health systems has made sub-national/regional healthcare systems the backbone of healthcare delivery. These regions are tasked with the difficult responsibility of determining healthcare priorities and resource allocation amidst scarce resources. We aimed to review empirical literature that evaluated priority setting practice at the meso level of health systems. Methods: We systematically searched PubMed, ScienceDirect and Google scholar databases and supplemented these with manual searching for relevant studies, based on the reference list of selected papers. We only included empirical studies that described and evaluated, or those that only evaluated priority setting practice at the meso-level. A total of 16 papers were identified from LMICs and HICs. We analyzed data from the selected papers by thematic review. Results: Few studies used systematic priority setting processes, and all but one were from HICs. Both formal and informal criteria are used in priority-setting, however, informal criteria appear to be more perverse in LMICs compared to HICs. The priority setting process at the meso-level is a top-down approach with minimal involvement of the community. Accountability for reasonableness was the most common evaluative framework as it was used in 12 of the 16 studies. Efficiency, reallocation of resources and options for service delivery redesign were the most common outcome measures used to evaluate priority setting. Limitations: Our study was limited by the fact that there are very few empirical studies that have evaluated priority setting at the meso-level and there is likelihood that we did not capture all the studies. Conclusions: Improving priority setting practices at the meso level is crucial to strengthening health systems. This can be achieved through incorporating and adapting systematic priority setting processes and frameworks to the context where used, and making considerations of both process and outcome measures during priority setting and resource allocation.

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“…*2 Baltussen et al, 2007;Defechereux et al, 2012;Duthie et al, 1999;Golan & Hansen, 2010;Venhorst et al, 2014;Youngkong et al, 2009. *3 Dionne et al, 2015Dolan, 2010;Duthie et al, 1999;Le Gales & Moatti, 1990;Gibson et al, 2006;Gurtner, 2014;Hilgerink et al, 2011;Johnson et al, 2009;Lasry et al, 2011;Mullen, 2004;Ritrovato et al, 2015;Tannahill, 2008;Wilson et al, 2006;Wilson et al, 2007;Youngkong et al, 2012a;Youngkong et al, 2012b. *4 de Greef-van der Sandt et al, 2016;Vuorenkoski et al, 2008;Youngkong et al, 2009. *5 Diaby & Goeree , 2014Goetghebeur et al, 2008;Goetghebeur et al, 2010;Goetghebeur et al, 2012;Golan & Hansen, 2010;Hailey, 2009;Menon et al, 2010;Miot et al, 2012;Mullen, 2004;Tony et al, 2011;University of York, 2002;Wilson et al, 2007. *6 Golan & Hansen, 2010;Johnson et al, 2009;Martin et al, 2001;Meagher, 2010;Noorani et al, 2007;Simoens, 2014;V...…”

Section: (("Decision Making"[mesh] Not Shar*[tiab]) or ("Decision Supunclassified

“…*30 Andreae et al, 2009;Baltussen et al, 2007;Defechereux et al, 2012;Diaby & Goeree, 2014;Diaby & Lachaine, 2011;Ghaffar, 2009;Gibson et al, 2006;Goetghebeur et al, 2008;Goetghebeur et al, 2010;Goetghebeur et al, 2012;Gurtner, 2014;Hailey, 2009;Jehu-Appiah et al, 2008;Kolasa et al, 2016;Koopmanschap et al, 2010;Lasry et al, 2011;Lopert, 2009;Menon et al, 2010;Miot et al, 2012;Mullen, 2004;Tannahill, 2008;Thokala & Duenas, 2012;Tony et al, 2011;University of York, 2002;Venhorst et al, 2014;Youngkong et al, 2009;Youngkong et al, 2012a. *31 Andreae et al, 2009;Lasry et al, 2011;Lopert, 2009;Youngkong et al, 2009. *32 Dionne et al, 2009;Golan & Hansen, 2010;Johnson et al, 2009;Kirby et al, 2008;Mullen, 2004. *33 Marsh et al, 2013;Menon et al, 2010;Venhorst et al, 2014.…”

Section: (("Decision Making"[mesh] Not Shar*[tiab]) or ("Decision Supunclassified

Análise de Decisão Multicritérios (MCDA): uma revisão rápida sobre os critérios utilizados na Avaliação de Tecnologias em Saúde

Souza¹,

Santos²,

Cintra³

2018

JBES

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RESUMOObjetivo: Identificar os vários critérios utilizados por agências e órgãos governamentais internacionais na Avaliação de Tecnologias em Saúde (ATS). Métodos: Foi realizada uma revisão rápida com busca estruturada na base de dados Medline (via PubMed) e Lilacs complementada por busca na literatura cinzenta, sem restrição de idioma. Incluíram-se estudos da área de saúde que descreviam critérios e que utilizaram o método MCDA (Análise de Decisão Multicritérios) na ATS. Excluíram-se estudos que avaliaram apenas uma tecnologia específica ou contexto restrito. Os critérios foram agregados e sumarizados conforme opinião de especialistas em ATS. Resultados: Foram identificadas 3.746 publicações, sendo 27 selecionadas. Os critérios extraídos foram categorizados e seus respectivos atributos foram listados. Dez categorias foram apresentadas: benefício e risco da intervenção (4 critérios); impacto da doença (4 critérios); impacto econômico (5 critérios); contexto terapêutico da intervenção (4 critérios); qualidade e incerteza da evidência (4 critérios); implementação da intervenção (5 critérios); benefícios para a sociedade (5 critérios); benefícios para o sistema de saúde público (5 critérios); benefícios para a indústria (1 critério); e outros (3 critérios). Os atributos mais prevalentes foram: custo-efetividade; segurança e tolerabilidade; impacto orçamentário para o sistema/plano de saúde; gravidade da doença; equidade; efetividade; custo. Conclusões: Os órgãos decisores utilizam grande variedade de critérios para o MCDA, refletindo visões e valores diferentes entre as culturas. O estudo fornece informação para discussão no contexto brasileiro de uma lista mais ampla e possível padronização de critérios a serem utilizados na tomada de decisão pública ou privada sobre a incorporação de novas tecnologias. ABSTRACTObjective: To identify the various criteria used by international government agencies and bodies in Health Technology Assessment (HTA). Methods: A rapid review was conducted with a structured search in the Medline database (via PubMed) and Lilacs supplemented by a search in the gray literature, without a restriction of language. Inclusion criteria were studies in health context, describing the criteria and using the MCDA (Multicriteria Decision Analysis) method in HTA. We excluded studies that assessed only one specific technology or restricted context. The criteria were aggregated and summarized according to the opinion of HTA experts. Results: A total of 3,746 publications were identified, of which 27 were selected. The extracted criteria were categorized, and their respective

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Ethics and economics: does programme budgeting and marginal analysis contribute to fair priority setting?

Abstract: There is potential for combining A4R and PBMA in a more comprehensive approach to priority setting, which uses a fair priority-setting process to reach decisions aimed at achieving optimal benefits with available resources.

Cited by 57 publications

References 14 publications

Moral Distress among Healthcare Managers: Conditions, Consequences and Potential Responses

Moral Distress among Healthcare Managers: Conditions, Consequences and Potential Responses

Evaluating healthcare priority setting at the meso level: A thematic review of empirical literature

Análise de Decisão Multicritérios (MCDA): uma revisão rápida sobre os critérios utilizados na Avaliação de Tecnologias em Saúde

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