Ethics and economics: does programme budgeting and marginal analysis contribute to fair priority setting?

Area of Science:

• Health economics
• Healthcare management
• Bioethics

Background:

• Limited resources necessitate effective priority-setting in healthcare.
• Programme Budgeting and Marginal Analysis (PBMA) is an economic tool for resource optimization.
• Accountability for Reasonableness (A4R) is an ethical framework for fair priority-setting processes.

Purpose of the Study:

• To evaluate the fairness of using PBMA for healthcare priority setting through the A4R framework.
• To assess how A4R can enhance the fairness of PBMA in resource allocation decisions.

Main Methods:

• Qualitative case studies were conducted in the Calgary Health Region.
• Programme Budgeting and Marginal Analysis (PBMA) was the priority-setting method examined.
• Accountability for Reasonableness (A4R) served as the conceptual framework for evaluation.

Main Results:

• PBMA demonstrated increased fairness in priority setting due to its explicit, rational decision-making process.
• Improvements identified include enhanced data collection on decision criteria, stakeholder communication plans, and formal dispute resolution mechanisms.
• Opportunities exist to refine PBMA implementation for greater transparency and equity.

Conclusions:

• Integrating A4R with PBMA offers a robust approach to healthcare priority setting.
• This combined strategy aims to achieve optimal resource utilization through fair and transparent processes.
• Further development can lead to more comprehensive and equitable healthcare resource allocation.