Social values and health priority setting in England: “values” based decision making

Sharma, Tarang; Jeong, Kim Shin

doi:10.1108/14777261211239007

Cited by 31 publications

(25 citation statements)

References 12 publications

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“…In their social value judgment document, existing debates on utilitarian and egalitarian approaches to distributive justice are mentioned in brief but NICE places emphasis largely on procedural justice, based on Daniels and Sabin’s [14] ‘accountability for reasonableness’. Despite the emphasis given to procedural justice or ‘process values’ [15], the cost per QALY calculation e appears to remain central to NICE recommendations [16]. …”

Section: Introductionmentioning

confidence: 99%

Extending life for people with a terminal illness: a moral right and an expensive death? Exploring societal perspectives

et al. 2015

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BackgroundMany publicly-funded health systems apply cost-benefit frameworks in response to the moral dilemma of how best to allocate scarce healthcare resources. However, implementation of recommendations based on costs and benefit calculations and subsequent challenges have led to ‘special cases’ with certain types of health benefits considered more valuable than others. Recent debate and research has focused on the relative value of life extensions for people with terminal illnesses. This research investigates societal perspectives in relation to this issue, in the UK.MethodsQ methodology was used to elicit societal perspectives from a purposively selected sample of data-rich respondents. Participants ranked 49 statements of opinion (developed for this study), onto a grid, according to level of agreement. These ‘Q sorts’ were followed by brief interviews. Factor analysis was used to identify shared points of view (patterns of similarity between individuals’ Q sorts).ResultsAnalysis produced a three factor solution. These rich, shared accounts can be broadly summarised as: i) ‘A population perspective – value for money, no special cases’, ii) ‘Life is precious – valuing life-extension and patient choice’, iii) ‘Valuing wider benefits and opportunity cost - the quality of life and death’.From the factor descriptions it is clear that the main philosophical positions that have long dominated debates on the just allocation of resources have a basis in public opinion.ConclusionsThe existence of certain moral positions in the views of society does not ethically imply, and pragmatically cannot mean, that all are translated into policy. Our findings highlight normative tensions and the importance of critically engaging with these normative issues (in addition to the current focus on a procedural justice approach to health policy). Future research should focus on i) the extent to which these perspectives are supported in society, ii) how respondents' perspectives relate to specific resource allocation questions, and iii) the characteristics of respondents associated with each perspective.

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Section: Introductionmentioning

confidence: 99%

Extending life for people with a terminal illness: a moral right and an expensive death? Exploring societal perspectives

et al. 2015

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“…In several scientific disciplines and social fields, Multi-criteria Decision Analysis is well developed, has achieved general acceptance and is consistently used [10][11][12][13]. There are only a very few applications of MCDA in health system research, even if this trend is increasing [14][15][16]. Multi-criteria Decision Analysis is a valuable tool to face many complex decisions involving multiple criteria goals or objectives of conflicting nature.…”

Section: An Emerging Tool In Decision-making: Mcdamentioning

confidence: 99%

Is it the time to rethink clinical decision-making strategies? From a single clinical outcome evaluation to a Clinical Multi-criteria Decision Assessment (CMDA)

et al. 2015

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“…Exploring how ‘deservingness’ is constructed in relation to health care becomes particularly salient at times of increasing pressure on NHS resources [30]. Although some researchers have explored ‘social values’ in health care rationing [31, 32], values are usually treated as pre-defined, fixed entities (for example ‘process’ values of transparency, accountability and participation, and ‘content’ values such as equity, solidarity and autonomy), that act as an ‘objective’ checklist to decision-making, rather than as contested, emergent and situated phenomena [33]. Our analysis aligns with those who view the process of ascribing value as an interpretive act involving ethical-moral choices, constructed moment-by-moment by social actors through interaction [34].…”

Section: Introductionmentioning

confidence: 99%

‘Cosmetic boob jobs’ or evidence-based breast surgery: an interpretive policy analysis of the rationing of ‘low value’ treatments in the English National Health Service

Russell

Swinglehurst

Greenhalgh

2014

BMC Health Serv Res

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BackgroundIn England the National Health Service (NHS) is not allowed to impose ‘blanket bans’ on treatments, but local commissioners produce lists of ‘low value’ procedures that they will normally not fund. Breast surgery is one example. However, evidence suggests that some breast surgery is clinically effective, with significant health gain. National guidelines indicate the circumstances under which breast surgery should be made available on the NHS, but there is widespread variation in their implementation.The purpose of this study was to explore the work practices of ‘individual funding request’ (IFR) panels, as they considered ‘one-off’ funding requests for breast surgery; examine how the notion of ‘value’ is dialogically constructed, and how decisions about who is deserving of NHS funding and who is not are accomplished in practice.MethodsWe undertook ethnographic exploration of three IFR panels. We extracted all (22) breast surgery cases considered by these panels from our data set and progressively focused on three case discussions, one from each panel, covering the three main breast procedures.We undertook a microanalysis of the talk and texts arising from these cases, within a conceptual framework of interpretive policy analysis.ResultsThrough an exploration of the symbolic artefacts (language, objects and acts) that are significant carriers of policy meaning, we identified the ways in which IFR panels create their own ‘interpretive communities’, within which deliberations about the funding of breast surgery are differently framed, and local decisions come to be justified. In particular, we demonstrated how each decision was contingent on [a] the evaluative accent given to certain words, [b] the work that documentary objects achieve in foregrounding particular concerns, and [c] the act of categorising. Meaning was constructed dialogically through local interaction and broader socio-cultural discourses about breasts and ‘cosmetic’ surgery.ConclusionDespite the appeal of calls to tackle ‘unwarranted variation’ in access to low priority treatments by ensuring uniformity of local guidelines and policies, our findings suggest that ultimately, given the contingent nature of practice, this is likely to remain an illusory policy goal. Our findings challenge the scientistic thinking underpinning mainstream health policy discourse.

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Social values and health priority setting in England: “values” based decision making

Cited by 31 publications

References 12 publications

Extending life for people with a terminal illness: a moral right and an expensive death? Exploring societal perspectives

Extending life for people with a terminal illness: a moral right and an expensive death? Exploring societal perspectives

Is it the time to rethink clinical decision-making strategies? From a single clinical outcome evaluation to a Clinical Multi-criteria Decision Assessment (CMDA)

‘Cosmetic boob jobs’ or evidence-based breast surgery: an interpretive policy analysis of the rationing of ‘low value’ treatments in the English National Health Service

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