Home and Community Care Digest
Lessons learned using an economic framework for resource allocation decisions in the Calgary Health Region
The purpose of this paper was to identify the priority setting issues that arose during the implementation of PBMA that are of importance to the decision makers who participated in the project.
Methods: The implementation of PBMA was discussed in a focus group involving the 8 individuals on the CHA's internal priority-setting committee and in 8 individual interviews with other senior managers. The transcripts of the interviews were thematically analysed.
Findings: Five general themes emerged during the focus group. First, decision makers found the comparisons of disparate patient groups during PBMA to be challenging. Although some researchers have proposed to develop a quantitative tool to aide this process, the participants believed that such a tool would obscure the social value and ethical issues laden in this process. They preferred to use a more pragmatic framework to guide decisions. Second, participants felt that any programmes considered to be political "givens" should be explicitly identified at the outset to reduce tension during the process. Third, participants felt that more emphasis should be placed on the ability of certain populations to benefit from health interventions. They were concerned about the variation in level of evidence available to judge the effectiveness of various programmes and were willing to accept evidence that does not meet the standards of "evidence-based medicine". Fourth, participants felt that innovation and the potential value of emerging treatments were not adequately accounted for in the PBMA framework. Finally, participants felt that the public should play a role in developing the criteria used to guide priority-setting decisions, but that they should not participate in the actual decisions themselves.
Conclusions: The researchers conclude that while PBMA is not a "magic bullet" for health authorities, it can be used to improve the transparency and fairness of the priority setting process. Decision makers faced with allocating health care dollars across competing programmes in regions across Canada, such as Ontario's new local health integration networks (LHINs), can potentially learn from the experiences of the managers in the Calgary Health Region.
Reference: Patten S, Mitton C, Donaldson C. "From the trenches: views from decision-makers on health services priority setting." Health Services Management Research, 2005; 18(2): 100 - 108.
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