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. 2015 Apr 17:15:164.
doi: 10.1186/s12913-015-0814-3.

'Real-world' health care priority setting using explicit decision criteria: a systematic review of the literature

Ian Cromwell  1   2 , Stuart J Peacock  3   4   5 , Craig Mitton  6   7
Affiliations

'Real-world' health care priority setting using explicit decision criteria: a systematic review of the literature

Ian Cromwell et al. BMC Health Serv Res. .

Abstract

Background: Health care decision making requires making resource allocation decisions among programs, services, and technologies that all compete for a finite resource pool. Methods of priority setting that use explicitly defined criteria can aid health care decision makers in arriving at funding decisions in a transparent and systematic way. The purpose of this paper is to review the published literature and examine the use of criteria-based methods in 'real-world' health care allocation decisions.

Methods: A systematic review of the published literature was conducted to find examples of 'real-world' priority setting exercises that used explicit criteria to guide decision-making.

Results: We found thirty-three examples in the peer-reviewed and grey literature, using a variety of methods and criteria. Program effectiveness, equity, affordability, cost-effectiveness, and the number of beneficiaries emerged as the most frequently-used decision criteria. The relative importance of criteria in the 'real-world' trials differed from the frequency in preference elicitation exercises. Neither the decision-making method used, nor the relative economic strength of the country in which the exercise took place, appeared to have a strong effect on the type of criteria chosen.

Conclusions: Health care decisions are made based on criteria related both to the health need of the population and the organizational context of the decision. Following issues related to effectiveness and affordability, ethical issues such as equity and accessibility are commonly identified as important criteria in health care resource allocation decisions.

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Figures

Figure 1
Figure 1
Search strategy and results.
Figure 2
Figure 2
Decision criteria by domain.
Figure 3
Figure 3
Criteria domain frequency by priority-setting method (PBMA vs. MCDA).
Figure 4
Figure 4
Criteria domain frequency by size of national economy (G7 vs. non-G7).
See this image and copyright information in PMC

References

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    1. Smith N, Mitton C, Peacock S, Cornelissen E, MacLeod S. Identifying research priorities for health care priority setting: a collaborative effort between managers and researchers. BMC Health Serv Res. 2009;9:165. doi: 10.1186/1472-6963-9-165. - DOI - PMC - PubMed
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    1. Mitton C, Donaldson C. Health care priority setting: principles, practice and challenges. Cost Effective Resour Alloc. 2004;2(1):3. doi: 10.1186/1478-7547-2-3. - DOI - PMC - PubMed

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