Priority Setting Toolkit: Guide to the Use of Economics in Healthcare Decision Making

Priority Setting Toolkit: A guide to the use of economics in healthcare decision making......Page 1
Priority Setting Toolkit: A guide to the use of economics in healthcare decision making......Page 3
Contents......Page 5
Preface......Page 7
Part 1: Background......Page 9
The priority setting challenge......Page 11
Two economic concepts......Page 13
Overview of this book......Page 16
Summary......Page 19
References......Page 20
Scarcity is here to stay......Page 22
For each dollar put in, what comes out?......Page 23
Opportunity costs......Page 25
Marginal analysis......Page 26
A decision matrix*......Page 27
Efficiency......Page 29
Equity......Page 31
Marginal analysis of one programme......Page 32
Marginal analysis of two programmes......Page 34
Marginal analysis of several programmes......Page 36
Summary......Page 38
References......Page 40
Part 2: Approaches to priority setting......Page 41
Introduction......Page 43
Characteristics......Page 44
Historical allocation and decibels......Page 45
Needs assessment......Page 46
Defining core services......Page 48
Accountability for Reasonableness......Page 50
Summary......Page 51
References......Page 52
Economic evaluation......Page 54
Cost–benefit analysis......Page 55
Strengths and weaknesses......Page 56
Cost-increasing scenarios and the incremental cost–effectiveness ratio......Page 57
Quality adjusted life year (QALY) league tables......Page 58
Levels of application and driving questions......Page 61
PBMA challenges......Page 63
Summary......Page 64
References......Page 65
Part 3: Programme budgeting and marginal analysis (PBMA)......Page 67
Scope and programme budget......Page 69
Advisory panel......Page 70
Decision making criteria......Page 71
Scoring options......Page 72
Supporting evidence and information......Page 74
Summary......Page 77
References......Page 78
Brief history of PBMA......Page 79
Use of PBMA internationally......Page 81
Impact of PBMA......Page 82
Organisational issues......Page 83
Summary......Page 85
References......Page 86
Appendix A: Publications on PBMA until March 2003......Page 88
Appendix B: Details of PBMA exercises......Page 93
Context......Page 100
Process used......Page 101
Lessons learned......Page 102
Process used......Page 104
Process results......Page 105
Link to ethical framework......Page 109
Summary......Page 111
References......Page 112
Part 4: Challenges to explicit priority setting......Page 113
Introduction......Page 115
Costs......Page 116
Benefits......Page 118
The challenge of time......Page 120
Conclusion......Page 122
References......Page 123
Setting the stage......Page 125
Thought experiments......Page 126
One-on-one interviews......Page 128
Setting the stage......Page 129
Examples of programme budgeting from Alberta......Page 130
Is the programme budget really necessary?......Page 132
References......Page 134
Introduction......Page 135
Generic QALYs......Page 136
Condition-specific QALYs......Page 139
Healthy year equivalents and QALYs......Page 140
Willingness to pay (WTP)......Page 141
Discrete choice experiments (DCEs)......Page 143
Using WTP and DCE data in healthcare decision making......Page 145
References......Page 148
Rationale for using the public......Page 151
Information to gain from the public......Page 152
Methods for engaging the public......Page 153
Summary......Page 156
References......Page 157
Introduction......Page 158
Australian insight......Page 159
Canadian insight......Page 160
Management literature......Page 161
Institutional economics literature......Page 163
The need for incentives......Page 165
Engaging stakeholders......Page 166
Rewarding innovative and efficient behaviour......Page 167
Incentives summary......Page 168
Challenges to physician involvement......Page 169
Roles for physicians......Page 170
Conclusion......Page 171
References......Page 172
Part 5: Conclusions......Page 175
Concepts and tools......Page 177
Process evaluation......Page 179
Recommendations......Page 180
Tying it all together......Page 182
Further endeavours......Page 183
Conclusion......Page 184
References......Page 185
Index......Page 186