Priority setting

Abstract

In everyday life and in health-care organizations, choices are constantly faced and ultimately made. When the choices are competing health-care resources, usually fiscal, this is called priority setting (formerly called resource allocation). A simple example would be the situation wherein enough money is left over in the budget for the neurosurgeons to buy one of two new pieces of equipment, but not both. Half the group wants one and the other half wants the other. How does the group decide? Is it based on who can give the most passionate argument or some more rational approach? This chapter introduces the surgeon to a bioethical framework that most surgeons are not familiar with-the accountability for reasonableness-to help ensure an ethical and fair process for setting resource priorities. Its four elements are relevance (decisions are made based on good and rational reasons), transparency (the results and the decision-making process are transparent to all the stakeholders), appeals (the stakeholders can appeal the decision if they feel the need), and oversight (an external individual/group monitors the results to ensure fairness).