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Severity of illness and priority setting in healthcare: A review of the literature

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  • Shah, Koonal K.

Abstract

Background It is widely assumed that the principal objective of healthcare is to maximise health. However, people may be willing to sacrifice aggregate health gain in order to direct resources towards those who are worst off in terms of the severity of their pre-treatment health state.Objectives This paper reviews the literature on severity in the context of economic evaluation, with the aim of establishing the extent to which popular preferences concerning severity imply a departure from the health maximisation objective.Methods Data were obtained using a keyword search of major databases and a hand search of articles written by leading researchers in the subject area.Results The empirical evidence suggests that people are, on the whole, willing to sacrifice aggregate health in order to give priority to the severely ill. However, there remain unresolved issues regarding the elicitation and interpretation of severity preferences (and indeed popular preferences generally).Conclusions The use of severity as a priority setting criterion is supported by a large number of empirical studies of popular preferences. Further work is needed, however, to accurately estimate the strength of this support.

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  • Shah, Koonal K., 2009. "Severity of illness and priority setting in healthcare: A review of the literature," Health Policy, Elsevier, vol. 93(2-3), pages 77-84, December.
    • Handle: RePEc:eee:hepoli:v:93:y:2009:i:2-3:p:77-84
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    1. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
    2. Dolan, Paul & Cookson, Richard, 2000. "A qualitative study of the extent to which health gain matters when choosing between groups of patients," Health Policy, Elsevier, vol. 51(1), pages 19-30, February.
    3. Tsuchiya, Aki, 1999. "Age-related preferences and age weighting health benefits," Social Science & Medicine, Elsevier, vol. 48(2), pages 267-276, January.
    4. Cookson, Richard & Dolan, Paul, 1999. "Public views on health care rationing: a group discussion study," Health Policy, Elsevier, vol. 49(1-2), pages 63-74, September.
    5. Green, Colin, 2009. "Investigating public preferences on 'severity of health' as a relevant condition for setting healthcare priorities," Social Science & Medicine, Elsevier, vol. 68(12), pages 2247-2255, June.
    6. Dolan, Paul & Tsuchiya, Aki, 2006. "Severity of illness and priority setting: Worrisome criticism of inconvenient finding?--A reply to Erik Nord," Journal of Health Economics, Elsevier, vol. 25(1), pages 173-174, January.
    7. A. J. Culyer, 1992. "The morality of efficiency in health care—some uncomfortable implications," Health Economics, John Wiley & Sons, Ltd., vol. 1(1), pages 7-18, April.
    8. Amos Tversky & Daniel Kahneman, 1991. "Loss Aversion in Riskless Choice: A Reference-Dependent Model," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 106(4), pages 1039-1061.
    9. Ryynänen, Olli-Pekka & Myllykangas, Markku & Kinnunen, Juha & Takala, Jorma, 1999. "Attitudes to health care prioritisation methods and criteria among nurses, doctors, politicians and the general public," Social Science & Medicine, Elsevier, vol. 49(11), pages 1529-1539, December.
    10. Alan Williams, 1997. "Intergenerational Equity: An Exploration of the ‘Fair Innings’ Argument," Health Economics, John Wiley & Sons, Ltd., vol. 6(2), pages 117-132, March.
    11. Nord, Erik, 1993. "The trade-off between severity of illness and treatment effect in cost-value analysis of health care," Health Policy, Elsevier, vol. 24(3), pages 227-238, August.
    12. Paul Dolan & Rebecca Shaw & Aki Tsuchiya & Alan Williams, 2005. "QALY maximisation and people's preferences: a methodological review of the literature," Health Economics, John Wiley & Sons, Ltd., vol. 14(2), pages 197-208, February.
    13. Jose‐Maria Abellan‐Perpiñan & Jose‐Luis Pinto‐Prades, 1999. "Health state after treatment: a reason for discrimination?," Health Economics, John Wiley & Sons, Ltd., vol. 8(8), pages 701-707, December.
    14. Jose–Luis Pinto Prades, 1997. "Is the Person Trade‐off a Valid Method for Allocating Health Care Resources?," Health Economics, John Wiley & Sons, Ltd., vol. 6(1), pages 71-81, January.
    15. Stolk, Elly A. & Pickee, Stefan J. & Ament, Andre H.J.A. & Busschbach, Jan J.V., 2005. "Equity in health care prioritisation: An empirical inquiry into social value," Health Policy, Elsevier, vol. 74(3), pages 343-355, November.
    16. Nord, Erik, 2006. "Severity of illness and priority setting: Worrisome lack of discussion of surprising finding," Journal of Health Economics, Elsevier, vol. 25(1), pages 170-172, January.
    17. Erik Nord, 1995. "The Person-trade-off Approach to Valuing Health Care Programs," Medical Decision Making, , vol. 15(3), pages 201-208, August.
    18. Dolan, Paul, 1998. "The measurement of individual utility and social welfare," Journal of Health Economics, Elsevier, vol. 17(1), pages 39-52, January.
    19. Gyrd-Hansen, Dorte, 2004. "Investigating the social value of health changes," Journal of Health Economics, Elsevier, vol. 23(6), pages 1101-1116, November.
    20. Ubel, Peter A., 1999. "How stable are people's preferences for giving priority to severely ill patients?," Social Science & Medicine, Elsevier, vol. 49(7), pages 895-903, October.
    21. Dolan, Paul & Tsuchiya, Aki, 2005. "Health priorities and public preferences: the relative importance of past health experience and future health prospects," Journal of Health Economics, Elsevier, vol. 24(4), pages 703-714, July.
    22. Richardson, Jeff & McKie, John, 2005. "Empiricism, ethics and orthodox economic theory: what is the appropriate basis for decision-making in the health sector?," Social Science & Medicine, Elsevier, vol. 60(2), pages 265-275, January.
    23. Paul Dolan & Colin Green, 1998. "Using the person trade‐off approach to examine differences between individual and social values," Health Economics, John Wiley & Sons, Ltd., vol. 7(4), pages 307-312, June.
    24. Erik Nord & Jose Luis Pinto & Jeff Richardson & Paul Menzel & Peter Ubel, 1999. "Incorporating societal concerns for fairness in numerical valuations of health programmes," Health Economics, John Wiley & Sons, Ltd., vol. 8(1), pages 25-39, February.
    25. Nord, Erik & Richardson, Jeff & Street, Andrew & Kuhse, Helga & Singer, Peter, 1995. "Maximizing health benefits vs egalitarianism: An Australian survey of health issues," Social Science & Medicine, Elsevier, vol. 41(10), pages 1429-1437, November.
    26. Ritov, Ilana & Baron, Jonathan, 1992. "Status-Quo and Omission Biases," Journal of Risk and Uncertainty, Springer, vol. 5(1), pages 49-61, February.
    27. Peter A. Ubel & George Loewenstein & Dennis Scanlon & Mark Kamlet, 1996. "Individual Utilities Are Inconsistent with Rationing Choices," Medical Decision Making, , vol. 16(2), pages 108-116, June.
    28. Jacobsson, Fredric & Carstensen, John & Borgquist, Lars, 2005. "Caring externalities in health economic evaluation: how are they related to severity of illness?," Health Policy, Elsevier, vol. 73(2), pages 172-182, August.
    29. Oddsson, Kristjan, 2003. "Assessing attitude towards prioritizing in healthcare in Iceland," Health Policy, Elsevier, vol. 66(2), pages 135-146, November.
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