Published 9 October 2008, doi:10.1136/bmj.a1846
Cite this as: BMJ 2008;337:a1846

Analysis

Clinical priority setting

¹ Department of Thoracic Medicine, Haukeland University Hospital, 5020 Bergen, Norway, ² Department of Public Health and Primary Care, University of Bergen, Kalfarveien 31, 5018 Bergen, Norway

Twelve years ago (BMJ 1996;312:1553-4) the BMJ argued that health systems needed to be explicit about rationing and published articles describing different ways of rationing fairly. Here a clinician, two ethicists (doi:10.1136/bmj.a1850), and four health economists (doi:10.1136/bmj.a1872) discuss how their ideas have developed—and been put into practice—since then

The first 150 words of the full text of this article appear below.

There are no simple solutions to resource allocation in health care,^{1 2} but the principles guiding fair priority setting are quite straightforward.^{3 4 5} This article explains the key principles and criteria for fair and clinically relevant priority setting. Clinicians should know these basic principles and be active in improving priority setting at all levels of the healthcare system.

Clinical priority setting means choosing whom to investigate and what diagnostic tests to perform; sorting the flow of patients so some are diagnosed or treated before others; allocating patients to surgery, medical treatment, or watchful observation; and selecting or excluding patients for a given treatment.^{6 7} Justice requires a fair distribution of the benefits and burdens of priority setting.⁸

Clinicians’ decisions rest on two types of information: the patient’s severity of disease (prognosis without the intervention) and the expected outcome (prognosis with the intervention). The evidence underlying their judgment is also important.⁹ Clinicians can help . . . [Full text of this article]

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This article has been cited by other articles:

• Hansen, P. (2009). Commentary on 'What is a priority?' by Paul Spicker. J Health Serv Res Policy 14: 117-118 [Full text]  
• Spicker, P. (2009). Author's response. J Health Serv Res Policy 14: 119-119 [Full text]  
• Goold, S. D., Baum, N. M (2008). Where are we in the rationing debate?. BMJ 337: a2047-a2047 [Full text]  

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