Interdisciplinary project on prioritisation in healthcare

The severity of a health condition plays an important role in the allocation of resources in most health systems, which is also supported when asking patients and citizens what is an important basis for allocation and is also partly regulated by legislation. In some cases, the assessment of severity can determine whether patients have access to treatment or not, for example when it comes to whether new medicines should be introduced in healthcare. At the same time, the use of severity has been criticised for being unclear and with an unclear ethical underpinning. This means that it is used with a variety of different and sometimes contradictory interpretations.

The project aims to develop a more ethically sound concept of severity to be used in health care resource allocation principles. The legal part of the project involves evaluating the proposed concept of severity (developed using ethical and health economic analysis methods) in the light of national and international law, but also in relation to the constitutional possibilities of legally regulating these issues.
The project uses empirical ethics as a methodology, which means that theoretical ethical analyses are combined with empirical investigations.

The project consists of four sub-projects:

• In the first sub-project, an ethical analysis is carried out, based on more general theories of justice. The two general theories of justice that seem most promising to investigate are prioritarianism and egalitarianism. Prioritarianism emphasises how much a person deviates from a certain benchmark level of value to be distributed, regardless of how well or poorly other people are doing. Egalitarianism emphasises how a person relates to other people in the system in terms of the value to be distributed, and that the difference is as small as possible. Further aspects that may play a role in how we assess severity are how we should relate to people's lives over time. Should we look at the person's whole life, or only the time we have in front of us? Should we take into account the age of the person, and assume, for example, that it is more difficult to suffer a fatal condition when young than when older? Other questions concern whether we should take into account how many people have been affected by a particular condition, or whether we should take into account that people other than patients are indirectly affected (e.g. family). The analysis in Subproject 1 is used to formulate a number of different severity models.
• These models are then tested in Subproject 2, using health economic analyses. The analyses aim to describe how the use of a particular severity model will affect resource allocation and thus health outcomes within the system. This means that in the project we also look at what displacement of care will occur with different models, i.e. which patient groups risk being left behind if we use a particular model.
• Subproject 3 examines how the models from subproject 1 should be viewed from a legal perspective, given both existing national and international regulation but also in relation to the possibility of legally regulating these issues.
• In a final sub-project, the results of all the sub-projects are brought together to arrive at the most ethically (and legally) reasonable severity model.