Identifying the Criteria Affecting Appropriate Allocation of Health System Resources to Different Diseases in Iran: A Qualitative Inquiry

Abstract

Background: Health policymakers need to use prioritization for resource allocation in the health system because of limitations to financial resources. Objectives: This study aimed to explore the criteria affecting the appropriate allocation of health system resources to different diseases. Methods: A qualitative study was carried out in 2017 using semi-structured interviews. Participants were chosen using purposeful and snowball sampling methods. Totally, 25 experts in the health care system were interviewed. The present study employed conventional content analysis and data were analyzed using MAXQDA10 software. Results: The findings were categorized into four main categories and 21 sub-categories. The main categories included criteria related to "type of disease", "patients' characteristics", "type of treatment", and "ethical and responsiveness issues". Furthermore, the most effective factors on resource allocation included the emergency or non-emergency aspects of the disease, disease severity, disease onset, treatment effectiveness, and disease prevention. Conclusions: Health policymakers should direct resources toward emergency and severe diseases that significantly affect people's quality of life. According to the findings of the present study, the "type of disease" was one of the most important criteria in health resources allocation. Therefore, similar to DRG, we can categorize diseases and health system problems based on their priority and use such grouping for health resources allocation.

Healthcare priority-setting criteria and social values in Iran: an investigation of local evidence

“…Among the selected studies, eighteen identified social values through the use of expert opinions (7;12;18;19;21–34). One study identified social values merely by analyzing policy documents and national evidence (12), while two studies involved a public survey to elicit social values (34;35).…”

“…A total of thirteen studies assigned weights to the criteria (19;22;24–27;29–34), while eight studies described the criteria qualitatively (7;12;18;21;23;28;30). The discrete choice experiment (31;34), technique for order of preference by similarity to ideal solution (25;27), the analytic hierarchy process (26;33) confirmatory factor analysis (30), and decision making trial and evaluation laboratory (32) methods had been applied to quantify the criteria.…”

How to fairly allocate scarce medical resources? Controversial preferences of healthcare professionals with different personal characteristics

“…We believe that physicians are generally better equipped to estimate a patient's imminence in risk of death, given a particular health condition, which may explain this discrepancy between both groups of healthcare practitioners. Having a low valorization of the patient's risk of death may raise concerns since there's some empirical evidence suggesting that Portuguese lay people (Pinho and Borges, 2015) as well as the general population in other countries (Dolan et al ., 2005; Krűtli et al ., 2016; Gu et al ., 2015; Pinho and Borges, 2018), health professionals (Lian, 2001; Arvidsson et al ., 2012; Krűtli et al, 2016; Pinho and Borges, 2021) and even experts in healthcare systems (Hadian et al ., 2019) feel the obligation to save, in the first place, those patients in emergency and life-threatening conditions.…”

“…The adherence of healthcare professionals to the waiting list criterion contrasts with international findings, where general practitioners contested this criterion (Krűtli et al ., 2016) or classified it as insignificant (Hadian et al ., 2019). Moreover, this finding does not support ethicists' normative claims that waiting time (first come, first served principle) is not morally justifiable (Persad et al ., 2009).…”

“…This criterion was contested by our participants even though it was ranked in the fourth place. Indeed, the healthcare professionals in this study tended to sanction those who are deemed responsible for their predicament, in an attitude that is aligned with that of lay persons (Lenton et al ., 2006; Wiseman, 2006; Luyten et al ., 2015; Pinho and Borges, 2018), but is contradicted by some theorists (Olsen et al ., 2003) and health experts elsewhere that judge this discrimination as incompatible with justice (Hadian et al ., 2019; Pinho and Borges, 2021). Moreover, the more the respondent was leaning to the political left (i.e., liberal orientation), the more likely he/she considered the negative merit to be a fair criterion to allocate scarce medical services.…”