Value Judgment of Health Interventions From Different Perspectives: Arguments and Criteria

Abstract

Background: The healthcare sector is evolving while life expectancy is increasing. These trends put greater pressure on healthcare resources, prompt healthcare reforms, and demand transparent arguments and criteria to assess the overall value of health interventions. There is no consensus on the core criteria by which to value and prioritize interventions, and individual stakeholders might value specific elements differently. The present study is based on a literature review that retrieved the most widely recognized arguments and criteria used in decision-making. The aim was to compile a smaller set of arguments and criteria that would seem most relevant to different stakeholders. Methods: A literature review was performed in Medline and EMBASE. The initial search retrieved over 2000 articles and documents of relevant committees. A selection was made based on their reference to healthcare, policy issues, or social justice. Finally, 84 papers were included. Data extraction took place after appraisal of the articles. A full table was made, including all arguments and criteria found; next, identical or largely overlapping arguments were excluded. The remaining arguments and criteria were assessed for relevance and a reduced set was compiled. Results: The final set included 25 arguments and criteria, categorized by type (clinical, social justice, ethical, and policy). For each argument and criterion, relevance to stakeholders was scored on three levels (not, partly, and completely relevant). Conclusions: Many arguments and criteria play a role in making value judgments on health interventions, but not all are relevant to all interventions. Moreover, they may interact with each other. A viable way to deal with interacting and possibly conflicting arguments and criteria might be to arrange public discussions that would evoke different stakeholders' perspectives.

How Far is Germany From Value-Based Pricing 10 Years After the Introduction of AMNOG?

“…Value-based pricing for pharmaceuticals was not a German novelty and has already being pursued in some European healthcare systems [3,4] and is currently being introduced in Japan, the second largest pharmaceutical market worldwide [5]. However, both criteria and measurement of the value of drugs can differ relatively widely depending on the healthcare system or stakeholder perspective [6,7]. Its theoretical origins for health services can be found in the well-known Harvard competitive strategist Porter [8,9], and in pharmaceutical supply, its precursor can be seen in Sweden after 2002 at a time when the term was not yet broadly used [10].…”

The patient as a policy problem: Ambiguous perceptions of a critical interface in healthcare

“…Rising service expectations from citizens and patients with regard to access, quality and involvement are increasingly set against limitations on financial resources and personnel (Saltman, 2015). If the patient starts to be regarded as an actor, or even as a co-producer of care, as opposed to a recipient of care, this will impact on the conditions for health policy-making (Vermeulen and Krabbe, 2018). How this is manifested depends on whether the change is understood as something that concerns only the meeting between the individual (patient) and the provider or if it is interpreted in broader strategic terms, as something important to the health system at large and its future design (Klein, 1993; Osborne and Strokosch, 2013; Salter, 2003; Vrangbaek, 2015).…”