Setting priorities in health care : Studies on equity and efficiency

Sammanfattning: The inevitable gap between needs and resources in health care, together with the problems associated with a market solution, necessitates priority setting. The aims of this thesis are associated with the process of priority setting in health care, and are divided into three issues:1.) To analyse the potential conflict between the two basic principles for priority setting: efficiency and equity. 2.) To analyse the significance of choice of method for measuring health-related status when determining who has the greatest need for health care. 3.) To analyse the possibilities to create an equation for translating results from a psychometricinstrument (the SF-36) into health utilities.The analyses are performed by use of literature studies, applications of methods for the measurement of health-related status, and comparative statistics.The equity principle is in this thesis interpreted to mean equality in the distribution of health. It is exemplified by Rawls' theory of justice, in turri taken to prescribe need as allocation principle. The efficiency principle is taken to mean cost-effectiveness according to welfare economics, i.e. in terms of utility maximisation. A preliminary result found is that the utility of health is declining on the margin. Vagueness concerning basic concepts thus might imply that the potential conflict between equity and efficiency is sometimes exaggerated. Further, methods used on the medical practice level and a general level respectively for the measurements of health-related status correspond more or less poorlywith one another. This might lead to contradicting decisions on resource allocation, and finding methods that correspond fairly might help linking the different levels together. Results from the SF-36 correlate only moderately with health utility equivalents on an individual level. However, equations for translating the SF-36 into health utilities on a group level, i.e. that discriminate correctly between groups, is probabiy feasible.