Health care priority setting in Norway a multicriteria decision analysis

Thierry Defechereux,Louis W Niessen,Andrew Mirelman,Grete Botten,Terje P Hagen,Sitaporn Youngkong,Francesco Paolucci

doi:10.1186/1472-6963-12-39

Abstract

BackgroundPriority setting in population health is increasingly based on explicitly formulated values. The Patients Rights Act of the Norwegian tax-based health service guaranties all citizens health care in case of a severe illness, a proven health benefit, and proportionality between need and treatment. This study compares the values of the country's health policy makers with these three official principles.MethodsIn total 34 policy makers participated in a discrete choice experiment, weighting the relative value of six policy criteria. We used multi-variate logistic regression with selection as dependent valuable to derive odds ratios for each criterion. Next, we constructed a composite league table - based on the sum score for the probability of selection - to rank potential interventions in five major disease areas.ResultsThe group considered cost effectiveness, large individual benefits and severity of disease as the most important criteria in decision making. Priority interventions are those related to cardiovascular diseases and respiratory diseases. Less attractive interventions rank those related to mental health.ConclusionsNorwegian policy makers' values are in agreement with principles formulated in national health laws. Multi-criteria decision approaches may provide a tool to support explicit allocation decisions.

Highlights

Priority setting in population health is increasingly based on explicitly formulated values
We used discrete choice experiments (DCE), a methodology that allows simultaneous assessment of multiple policy preferences in multi-criteria decision analysis (MCDA) for policy as we reported earlier in other case studies[9,13,14,15]
MCDA consists of four steps: (I) identification of policy criteria and metrics, (II) identifying series of alternative package vignettes based on various combinations of policy criteria, (III) measuring performance of alternatives by criteria, and (IV) determining the preferred selection through scoring intervention options against those criteria

Summary

Introduction

Priority setting in population health is increasingly based on explicitly formulated values. In all health care systems, choices in the allocation of resources are necessary. Public resources, in both lowand high-income settings, are insufficient to provide all possible services to the entire population at all times. Priority setting in the allocation of health interventions across ranges of health services or target groups becomes inevitably and at best should be explicit[1,2]. Scarcity of resources and rational priority setting lead to identification of national packages of health services and to explicit reimbursement decisions [3]. The rise of evidence-based health policy has lead to a wealth of information on the nature and distribution of the disease

Methods

Results

Conclusion