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HELSEVEL-Gode og effektive helse-, omsorgs- og velferdstjenester

Severity and priority setting in health care

Alternative title: Alvorlighet og helseprioriteringer

Awarded: NOK 12.2 mill.

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Project Period:

2020 - 2024


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Severity as a priority setting criterion has remained a cornerstone of Norwegian priority setting following the first Lønning commission in 1987 and through the later priority setting commissions (Norheim 2014, Blankholm 2018). The seeming consensus on severity as a priority criterion is less clear-cut upon closer scrutiny. Do we all think of the same thing when we describe a condition as 'severe'? Is severity sufficiently well-defined to form the basis for good priority setting that the population will endorse? What do professionals like health workers, economists, or politicians think of? What do the patients themselves think, and does severity mean the same in Alta and in Oslo? SEVPRI will chart what meanings are attached to the concept of severity in general, and for priority setting in health care in particular. Is severity about pain, loss of function, and death? The patient's social context? Distributive concerns? Is severity here-and-now, or, is it a life-span matter? By interviewing a wide range of people SEVPRI will obtain qualitative raw material for further analysis. Different quantitative and qualitative methods will be used to describe the diversity of opinions from different theoretical frameworks. The research group is broadly composed with philosophers, economists, and health professionals. SEVPRI will analyse severity as a priority setting criterion as exhaustively as possible, so that we can distinguish areas of consensus from areas of real disagreement. The goal is to improve the language of the public priority setting conversation, so that priority setting in health care can be perceived as fair by as many as possible, facilitating acceptable compromises where disagreement is unresolvable.

The aim of SEVPRI is to achieve a better public discussion about priority setting. It is about understanding how peoples' values impact their views on priority setting in health care, and about translating this into criteria for priority setting that achieve the ideal of democratic, open, and fair priority setting in health care. The duty to first direct resources to the most severely ill appears widespread, and many health jurisdictions today employ a 'severity' criterion. These criteria are often interpreted as a counterbalance to the cost-per-Quality Adjusted Life-Year (QALY) criterion; a utilitarian criterion. But, what does severity really mean in this context? The academic literature does not contain clear answers, and the public debate reveals very different views on this issue. SEVPRI sets out to improve on this state. By gauging the public’s subjective views on severity and fairness with qualitative and quantitative methods, and subjecting these views to analysis by a multidisciplinary team including leading philosophers, economists, psychologists and physicians, we will characterise the public's various views about what severity and fairness means to people by systematically mapping these views to ethical theories. We will also ascertain which non-utilitarian concerns can be integrated within the utilitarian QALY-models, and analyse the moral tensions between discovered ethical values. The most critical phases of SEVPRI are data-acquisition – when our researchers will enter in a dialogue with the public through country-wide workshops – and the dissemination of our outcomes to a wide audience of citizens, policy makers and politicians. With an impressive team, with expertise and experience that will help to surmount these challenges, SEVPRI will change how philosophers think about severity, how health economists construct their formalisms, and how we speak about priority setting both as citizens, as health professionals and as policy makers.

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HELSEVEL-Gode og effektive helse-, omsorgs- og velferdstjenester