Who gets priority? Severity is not enough for diagnostics
Healthcare resource allocation is a challenge not only for treatments but also for diagnostic measures.
Many tests and tools used for diagnosis are expensive. For long, the principle of severity has been used in decisions about drug pricing. Now, Uppsala and Linköping researchers are examining whether it can be used to prioritise between diagnostic measures.
Niklas Juth is professor of clinical medical ethics.
Prioritising resources is a necessary evil of any healthcare system. In the Netherlands, Norway, Sweden and the UK, severity has been used as a prioritisation criterion for a long time. Primarily in decisions about treatment costs. A treatment for a mild condition like a seasonal allergy is expected to be cheaper and a treatment for a severe condition like heart attacks or cancer can cost more. A recent Health Care Analysis publication explores what happens when the same principle is applied to the process of diagnosis.
One major difference is that diagnostic measures start from the opposite end of the spectrum. Instead of targeting a specific disease or condition, like diabetes or a specific cancer, the same diagnostic tool can be used for a very large and diverse group of patients. For example, a CT scan can be used for headaches, injuries, suspected cancer, infections and more. A standard blood test can be used to investigate countless illnesses.
“The severity criterion works best when you know what disease the patient has, how severe it is, and who has it,” says Niklas Juth, professor of clinical medical ethics at Uppsala University’s Centre for Research Ethics & Bioethics and one of the authors of the Health Care Analysis publication.
With diagnostic tools, you don’t yet know what condition the patient is suffering from – that’s why the test is being done. Different people getting the same test done may have conditions ranging from mild to extremely severe, and some may not have a condition at all.
Secondary findings further complicate severity-based priority setting. An ultrasound for suspected gallstones might reveal an enlarged abdominal aorta. This challenges the idea that priorities can be based on the severity of the target condition – because secondary findings can reveal more than one.
There is also the issue of treatability. Sometimes we are diagnosed with conditions that can’t be treated. Non-treatability does not match well with the severity criterion, because this usually justifies spending more only when health outcomes can actually improve. Without treatment, the value of a diagnostic test no longer aligns with the severity-based logic, instead values like personal autonomy come into play.
“Where treatments offer clarity, diagnostics return complexity – and a fair and consistent healthcare system must be able to handle both,” Niklas Juth concludes.
By Anna Holm Bodin
Gustavsson, E., Juth, N. Severity as a Criterion for Prioritizing Diagnostic Measures. Health Care Analysis (2026). DOI: 10.1007/s10728-026-00561-6
Just Severity
Priority setting in healthcare often hinges on the perceived severity of a condition. But who decides what is severe, and on what grounds? The Just Severity project, funded by the Swedish Research Council, explores will develop a more ethically sound concept of severity.