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      Guidance on priority setting in health care (GPS-Health): the inclusion of equity criteria not captured by cost-effectiveness analysis

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          Abstract

          This Guidance for Priority Setting in Health Care (GPS-Health), initiated by the World Health Organization, offers a comprehensive map of equity criteria that are relevant to health care priority setting and should be considered in addition to cost-effectiveness analysis. The guidance, in the form of a checklist, is especially targeted at decision makers who set priorities at national and sub-national levels, and those who interpret findings from cost-effectiveness analysis. It is also targeted at researchers conducting cost-effectiveness analysis to improve reporting of their results in the light of these other criteria.

          The guidance was develop through a series of expert consultation meetings and involved three steps: i) methods and normative concepts were identified through a systematic review; ii) the review findings were critically assessed in the expert consultation meetings which resulted in a draft checklist of normative criteria; iii) the checklist was validated though an extensive hearing process with input from a range of relevant stakeholders.

          The GPS-Health incorporates criteria related to the disease an intervention targets (severity of disease, capacity to benefit, and past health loss); characteristics of social groups an intervention targets (socioeconomic status, area of living, gender; race, ethnicity, religion and sexual orientation); and non-health consequences of an intervention (financial protection, economic productivity, and care for others).

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          Most cited references31

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          Defining equity in health

          P Braveman (2003)
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            Understanding DALYs (disability-adjusted life years).

            The measurement unit disability-adjusted life years (DALYs), used in recent years to quantify the burden of diseases, injuries and risk factors on human populations, is grounded on cogent economic and ethical principles and can guide policies toward delivering more cost-effective and equitable health care. DALYs follow from a fairness principle that treats 'like as like' within an information set comprising the health conditions of individuals, differentiated solely by age and sex. The particular health state weights used to account for non-fatal health outcomes are derived through the application of various forms of the person trade-off.
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              Intergenerational equity: an exploration of the 'fair innings' argument.

              Many different equity principles may need to be traded off against efficiency when prioritizing health care. This paper explores one of them: the concept of a 'fair innings'. It reflects the feeling that everyone is entitled to some 'normal' span of health (usually expressed in life years, e.g. 'three score years and ten') and anyone failing to achieve this has been cheated, whilst anyone getting more than this is 'living on borrowed time'. Four important characteristics of the 'fair innings' notion are worth noting: firstly, it is outcome based, not process-based or resource-based; secondly, it is about a person's whole life-time experience, not about their state at any particular point in time; thirdly, it reflects an aversion to inequality; and fourthly, it is quantifiable. Even in common parlance it is usually expressed in numerical terms: death at 25 is viewed very differently from death at 85. But age at death should be no more than a first approximation, because the quality of a person's life is important as well as its length. The analysis suggests that this notion of intergenerational equity requires greater discrimination against the elderly than would be dictated simply by efficiency objectives.
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                Author and article information

                Contributors
                Journal
                Cost Eff Resour Alloc
                Cost Eff Resour Alloc
                Cost Effectiveness and Resource Allocation : C/E
                BioMed Central
                1478-7547
                2014
                29 August 2014
                : 12
                : 18
                Affiliations
                [1 ]Department of Global Public Health and Primary Care, University of Bergen, PB 7800, 5020 Bergen, Norway
                [2 ]Nijmegen International Centre for Health Systems Research and Education (NICHE), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
                [3 ]Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Québec, Canada
                [4 ]Department of Health Systems Financing, World Health Organization, Geneva, Switzerland
                [5 ]Norwegian Institute of Public Health, Oslo, Norway
                [6 ]Harvard Medical School, Harvard University, Cambridge, USA
                [7 ]National Centre for Priority Setting in Health Care, Linköping University, Linköping, Sweden
                [8 ]Centre for Health Economics, University of York, York, UK
                [9 ]Harvard School of Public Health, Harvard University, Cambridge, USA
                [10 ]Section on Ethics and Health Policy, NIH Clinical Centre, Bethesda, USA
                [11 ]Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, USA
                [12 ]Department of Health, Aging, and Society, McMaster University, Hamilton, Canada
                [13 ]Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King’s College London, Previous affiliation the National Institute for Health and Care Excellence (NICE), London, England, UK
                [14 ]Ministry of Health and Social Services, Windhoek, Namibia
                [15 ]Public Health Foundation of India, New Delhi, India
                Article
                1478-7547-12-18
                10.1186/1478-7547-12-18
                4171087
                25246855
                4f0c9683-f110-4e14-aa7d-4ee8a7652a09
                Copyright © 2014 Norheim et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 5 April 2014
                : 18 July 2014
                Categories
                Methodology

                Public health
                priority setting,resource allocation,cost-effectiveness,equity,population health
                Public health
                priority setting, resource allocation, cost-effectiveness, equity, population health

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