Should Severity Assessments in Healthcare Priority Setting be Risk- and Time-Sensitive?

Area of Science:

• Health economics
• Medical ethics
• Public health policy

Background:

• Healthcare priority setting relies heavily on severity assessment.
• The concept of severity in healthcare is under-theorized, leading to debate.
• A key controversy is whether severity should be sensitive to risk and/or time.

Purpose of the Study:

• To provide a normative analysis of whether healthcare severity should be risk- and/or time-sensitive.
• To explore the implications of risk and time sensitivity in severity assessment for healthcare priority setting.

Main Methods:

• A reflective equilibrium approach was employed.
• Judgments and arguments regarding severity in preventive care were analyzed.
• Consistency was sought between severity assessments and broader normative theories of priority setting.

Main Results:

• Risk-sensitive severity assessment may dilute the perceived severity, potentially deprioritizing effective preventive treatments.
• The relevance of risk in severity assessment depends on the defined population (e.g., whole population at risk vs. future affected individuals).
• Time-sensitive severity arguments are strengthened by the potential for future technological advancements, suggesting individualized discounting.

Conclusions:

• Discounting severity based on risk or time has significant implications for healthcare prioritization, especially for preventive interventions.
• Careful consideration of population delineation and future technological developments is crucial when assessing risk and time sensitivity.
• Systemic effects of making severity risk- and time-sensitive must be thoroughly evaluated to ensure equitable healthcare resource allocation.