Who's next? : a new process for creating points systems for prioritising patients for elective health services

We describe a new process for creating points systems for prioritising patients for elective health services. Beginning in 2004, the authors were closely involved in a project to develop the process, initially for coronary artery bypass graft surgery and then successively for other elective services. The project was led by New Zealands Ministry of Health in collaboration with the relevant clinical professional organisations. The objective was to overcome the limitations of earlier methodologies and to create points systems that are valid and reproducible and based on a consensus of clinical judgements. As the project progressed and the process was refined, other points systems were successively created (and clinically endorsed) for hip and knee replacements, varicose veins surgery, cataract surgery, gynaecology, plastic surgery, otorhinolaryngology, and heart valve surgery. Other points systems are planned for the future. Since 2008 the process has also been used in the public health systems of Canadas western provinces. The process is explained in a step-by-step manner so that others are able to follow it to create their own points systems if desired.