Project

SEVPRI - Severity and Priority Setting in Health care

Goal: 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.

Date: 1 January 2020 - 31 December 2024

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Project log

Carl Tollef Solberg
added a research item
In Norway, priority for health interventions is assigned on the basis of three official criteria: health benefit, resources, and severity. Responses to the COVID-19 pandemic have mainly happened through intersectoral public health efforts such as lockdowns, quarantines, information campaigns, social distancing and, more recently, vaccine distribution. The aim of this article is to evaluate potential priority setting criteria for public health interventions. We argue in favour of the following three criteria for public health priority setting: benefit, resources and improving the well-being of the worse off. We argue that benefits and priority to the worse off may reasonably be understood in terms of individual well-being, rather than only health, for public health priority setting. We argue that lessons from the COVID-19 pandemic support our conclusions. Keywords: COVID-19, Prioritarianism, Priority Setting, Public Health, Severity
Sindre August Horn
added a research item
Koronapandemien har synliggjort nødvendigheten av prioriteringer i helsetjenesten vår. Helseprioriteringer i Norge skal gjøres etter de tre kriteriene nytte, ressurs og alvorlighetsgrad. Nytte-og ressurskriteriene utgjør til sammen et kostnadseffektivitetskriterium: Høyere prioritet tilfaller tiltak som skaper mye helse med få ressurser. Alvorlighets-kriteriet innebaerer at en mer alvorlig tilstand kan og skal prioriteres høyere enn kostnadseffektiviteten alene tilsier. I denne artikkelen undersøker vi det norske alvorlighetskriteriet for helseprioriteringer i møte med koronaepidemien i Norge. Vi beskriver utviklingen av alvorlighetskriteriet i den norske prioriteringsdiskursen. Videre diskuterer vi hvordan koronaepidemien fremhever uenigheter og tvetydigheter rundt begrepet «alvorlighet» hva gjelder dødsrisiko, komorbiditet og hastegrad. Vi drøfter også hvordan den norske pandemiberedskapen passer inn i dette landskapet og etterlyser en klarere forståelse av alvorlighet i skillet mellom behandling og forebygging av sykdom. Til sist drøfter vi om det norske alvorlighetskriteriet for helseprioriteringer også kan være relevant for prioriteringer utenfor helsevesenet.
Mathias Barra
added an update
We have now commenced with arranging Q-conversations about severity with participants in Norway. DO you know anyone (must be able to converse in Norwegian about the topic of "alvorlighet") who would be interested in pariticpating? See the attached document, or use the link below:
 
Mathias Barra
added an update
SEVPRI's main conjecture is that the concept of 'severity' as a (decision) criterion for priority setting in health is undertheorised and poorly understood. We believe this contributes to misunderstandings and lower legitimacy of priority setting decisions in the public health sector. We therefore have set out to talk with the public about their views on this issue. Later, we will subject their views to Q-methodology studies, investigate the prevalence of different accounts of severity, analyse their views from ethical and economic vantage points. A separate work package will pursue the link between severity and fairness of distribution. We hope and expect that our finding will mitigate arguments, help clarify opposing positions, and lead to a better debate on priority setting.
 
Carl Tollef Solberg
added a research item
Målet med denne artikkelen er å undersøke de viktigste argumentene for og imot diskontering av fremtidige helsegevinster. Et mer generelt spørsmål dreier seg om hvorvidt vi bør diskontere fremtidig velferd (eng. well-being). Vi begynner med en redegjørelse av hva diskontering er, og hvordan diskontering påvirker evaluering av helsetiltak. Deretter tar vi for oss de mest sentrale argumentene for og imot diskontering av fremtidige helsegevinster. Dette inkluderer velkjente argumenter som grensenytteargumentet, risikoargumentet, utsettelsesargumentet, konsistensargumentet og rene positive tidspreferanser. I tillegg drøfter vi to lite diskuterte argumenter, nemlig det instrumentelle argumentet og argumentet for fordelingsrettferdighet, samt en alternativ form for diskontering, nemlig diskontinuerlig diskontering. Vi konkluderer åpent og lar det være opp til deg som leser å reflektere videre omkring dette viktige spørsmålet.
Carl Tollef Solberg
added a research item
I en ideell verden ville vi alle fått medisinsk behandling etter behov. Men i virkeligheten danner ressursknapphet selve rammen for vår eksistens: Vi må prioritere, og velge noe foran noe annet.
Mathias Barra
added a research item
In a recent extended essay, philosopher Daniel Hausman goes a long way towards dismissing severity as a morally relevant attribute in the context of priority setting in healthcare. In this response, we argue that although Hausman certainly points to real problems with how severity is often interpreted and operationalised within the priority setting context, the conclusion that severity does not contain plausible ethical content is too hasty. Rather than abandonment, our proposal is to take severity seriously by carefully mapping the possibly multiple underlying accounts to well-established ethical theories, in a way that is both morally defensible and aligned with the term’s colloquial uses.
Mathias Barra
added an update
SEVPRI is currently drafting the announcement for two fully financed three year PhD positions: one for a qualitative and quantitative work package based on Q-methodology that will describe the various accounts of severity in Norway, and one work package on severity, priority setting and inequity. Fluency in Norwegian language will be for the Q-methodology WP, and work place will be Lørenskog/Oslo, Norway. The second will be based in Bergen, Norway. Stay tuned!
 
Mathias Barra
added an update
The SEVPRI programme was notified of the allocation of 12M NOK for the period 2020-2024 from RCN on the 18th of Desember. We will now activate the project partners and start planning for 5 exiting years of research and interaction with the Norwegian public about how they understand severity in the context of priority setting in health care.
Follow us here, and also on twitter (@SEVPRI1), for updates, upcoming PhD and PostDoc positions, recruitment of survey participants, public events, and more.
 
Mathias Barra
added a research item
Caveat: The first posted pdf of this paper contained extensive misreferencing. Please download this updated version. Priority setting in health care is ubiquitous and health authorities are increasingly recognising the need for priority setting guidelines to ensure efficient, fair, and equitable resource allocation. While cost-effectiveness concerns seem to dominate many policies, the tension between utilitarian and deontological concerns is salient to many, and various severity criteria appear to fill this gap. Severity, then, must be subjected to rigorous ethical and philosophical analysis. Here we first give a brief history of the path to today's severity criteria in Norway and Sweden. The Scandi-navian perspective on severity might be conducive to the international discussion, given its long-standing use as a priority setting criterion, despite having reached rather different conclusions so far. We then argue that severity can be viewed as a multidimensional concept, drawing on accounts of need, urgency, fairness, duty to save lives, and human dignity. Such concerns will often be relative to local mores, and the weighting placed on the various dimensions cannot be expected to be fixed. Thirdly, we present what we think are the most pertinent questions to answer about severity in order to facilitate decision making in the coming years of increased scarcity , and to further the understanding of underlying assumptions and values that go into these decisions. We conclude that severity is poorly understood, and that the topic needs substantial further inquiry; thus we hope this article may set a challenging and important research agenda. https://link.springer.com/article/10.1007/s10728-019-00371-z
Mathias Barra
added an update
SEVPRI submitted a grant proposal to the Norwegian research Council on April 10th 2019; expecting an answer by the end of December 2019.
 
Mathias Barra
added a project goal
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.