Priority Setting in the 'Real-World' - from Principles to Processes and Performance

Economics should provide the theory and solutions to help healthcare organizations make priority setting decisions. However, the impact of economics and health economic methods in particular on such decision-making is not clear. This presentation draws together research conducted in the England, Canada and Australia which sought to address how priority setting is understood in principle by decision-makers (i.e. how it ought to be undertaken) and how this translates in practice (i.e. how it is undertaken). Semi-structured interviews were conducted with key decision-makers in local/regional healthcare organizations in each country (>100). The transcripts formed the formal data for analysis and qualitative methods were used to identify broad themes and sub-themes. The results for each country as well as common themes across these countries are presented. These describe the context of priority setting in terms of: the guiding principles - there seems to be a general understanding and acceptance of resources scarcity and the need to make choices. In some cases decision makers can articulate specific criteria by which this should be done. the driving processes - priority setting decisions seem to be driven largely by history and politics. The use of evidence based approaches is less developed. the resulting performance - priority setting decisions do not seem to be made in an explicit, transparent, or accountable way. Organizations and individuals find it difficult to 'manage' priority setting decisions due to a lack of capacity, capability, and support. We discuss the implications of these results in terms of developing health economic methods for priority setting