A Framework for Involving the Public in Health Care Coverage and Resource Allocation Decisions

IntroductionData linkage of population data sets often across jurisdictions or linking health data sets or health data with non-health data often involves balancing ethical principles such as privacy with beneficence as represented by the public good. Similar ethical dilemmas occur in health resource allocation decisions. The NHMRC have published a framework to guide policy on health resource allocation decisions that could be applied to ensure the justification of data linkage projects that is defensible as in the interest of the public good. Objectives and ApproachThe four main conditions for legitimacy of policy decisions about access to healthcare in a democracy with a public health system and limited resources wereexamined for their relevance to decisions about the use of public data and linking data sets. ResultsPublic policy decisions must be defensible and responsive to the interests of those affected. Decision-makers should articulate their reasoning and recommendations so that citizens can judge them. While the context of policy decisions will differ, their legitimacy depends upon (1) the transparency of the reasoning which should be free from conflicts of interest, the basis for decisions recorded and report widely, (2) the accountability of the decision-makers to the wider community, (3) the testability of the evidence used to inform the decision-making, which usually means that it will stand up to independent review and(4) the inclusive recognition of those the decision affects which often requires that the implications for disadvantaged groups are considered, even if they can’t always be accommodated. These conditions are interrelated but ensure that the good of society in general and not just specific dominant groups are accommodated. Conclusion / ImplicationsIt these principles are applied to decisions about data linkage projects they have clear applicability in society accepting data linkage projects having balanced the good against the ethical risks involved.

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Discussion: Drummond's “resource allocation decisions in health care: A role for quality of life assessment?”

Journal of Chronic Diseases ◽

10.1016/0021-9681(87)90022-1 ◽

1987 ◽

Vol 40 (6) ◽

pp. 617-619 ◽

Cited By ~ 4

Author(s):

Jane E. Sisk

Keyword(s):

Quality Of Life ◽

Health Care ◽

Resource Allocation ◽

Life Assessment ◽

Quality Of Life Assessment ◽

Allocation Decisions ◽

Resource Allocation Decisions

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The Role of the Courts in Shaping Health Policy: An Empirical Analysis

The Journal of Law Medicine & Ethics ◽

10.1111/j.1748-720x.2001.tb00348.x ◽

2001 ◽

Vol 29 (3-4) ◽

pp. 278-289 ◽

Cited By ~ 5

Author(s):

Peter D. Jacobson ◽

Elizabeth Selvin ◽

Scott D. Pomfret

Keyword(s):

Health Care ◽

Resource Allocation ◽

Managed Care ◽

Cost Containment ◽

Financial Incentives ◽

Access To Health Care ◽

Care Delivery ◽

Care Utilization ◽

Allocation Decisions ◽

Resource Allocation Decisions

The transformation of health-care delivery from fee-for-service medicine to managed care represents a fundamental philosophical shift away from the prevailing medical ethos that the needs of the individual patient take precedence over competing social values, such as reducing health-care costs. In managed care, financial incentives to reduce health-care utilization may result in denying an individual’s claim for medical services.Litigation challenging managed care’s resource allocation decisions often presents the need to resolve conflicting social policy goals, such as the tension between an individual patient’s access to health care and a managed care organization’s (MCO’s) need to restrain costs. Conflicts may arise when a patient’s desire for unconstrained health care clashes with a provider’s and an insurer’s cost containment strategies. In turn, cost containment strategies may raise questions about restrictions on physician autonomy and conflicts among stakeholders for control over resource allocation decisions.

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CASE STUDIES THAT ILLUSTRATE DISINVESTMENT AND RESOURCE ALLOCATION DECISION-MAKING PROCESSES IN HEALTH CARE: A SYSTEMATIC REVIEW

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462313000068 ◽

2013 ◽

Vol 29 (2) ◽

pp. 174-184 ◽

Cited By ~ 52

Author(s):

Julie Polisena ◽

Tammy Clifford ◽

Adam G. Elshaug ◽

Craig Mitton ◽

Erin Russell ◽

...

Keyword(s):

Health Care ◽

Decision Making ◽

Resource Allocation ◽

Case Studies ◽

Resource Allocation Decision ◽

Cochrane Library ◽

Fee For Service ◽

Allocation Decision ◽

Allocation Decisions ◽

Resource Allocation Decisions

Objective:Technological change accounts for approximately 25 percent of health expenditure growth. To date, limited research has been published on case studies of disinvestment and resource allocation decision making in clinical practice. Our research objective is to systematically review and catalogue the application of frameworks and tools for disinvestment and resource allocation decision making in health care.Methods:An electronic literature search was executed for studies on disinvestment, obsolete and ineffective technologies, and priority healthcare setting, published from January 1990 until January 2012. Databases searched were MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, Embase, The Cochrane Library, PubMed, and HEED.Results:Fourteen case studies on the application of frameworks and tools for disinvestment and resource allocation decisions were included. Most studies described the application of program budgeting and marginal analysis (PBMA), and two reports used health technology assessment (HTA) methods for coverage decisions in a national fee-for-service structure. Numerous healthcare technologies and services were covered across the studies. We describe the multiple criteria considered for decision making, and the strengths and limitations of these frameworks and tools are highlighted.Conclusions:Disinvestment and resource allocation decisions require evidence to ensure their transparency and objectivity. PBMA was used to assess resource allocation of health services and technologies in a fixed budget jurisdiction, while HTA reviews focused on specific technologies, principally in fee-for-service structures. Future research can review the data requirements and explore opportunities to increase the quantity of available evidence for disinvestment and resource allocation decisions.

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