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Looking back and moving forward: On the application of proportional shortfall in healthcare priority setting in the Netherlands

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  • Reckers-Droog, V.T.
  • van Exel, N.J.A.
  • Brouwer, W.B.F.

Abstract

The increasing demand for healthcare and the resulting pressure on available budgets render priority setting inevitable. If societies aim to improve health and distribute health(care) fairly, equity-efficiency trade-offs are necessary. In the Netherlands, proportional shortfall (PS) was introduced to quantify necessity of care, allowing a direct equity-efficiency trade-off. This study describes the history and application of PS in the Netherlands and examines the theoretical and empirical support for PS as well as its current role in healthcare decision making. We reviewed the international literature on PS from 2001 onwards, along with publicly accessible meeting reports from the Dutch appraisal committee, Adviescommissie Pakket (ACP), from 2013 to 2016. Our results indicate that there is support for the decision model in which necessity is quantified and incremental cost-effectiveness ratios are evaluated against associated monetary reference values. The model enables a uniform framework for priority setting across all healthcare sectors. Although consensus about the application of PS has not yet been reached and alternative ways to quantify necessity were found in ACP reports, PS has increasingly been applied in decision making since 2015. However, empirical support for PS is limited and it may insufficiently reflect societal preferences regarding age and reducing lifetime-health inequalities. Hence, further investigation into refining PS—or exploration of another approach—appears warranted for operationalising the equity-efficiency trade-off.

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  • Reckers-Droog, V.T. & van Exel, N.J.A. & Brouwer, W.B.F., 2018. "Looking back and moving forward: On the application of proportional shortfall in healthcare priority setting in the Netherlands," Health Policy, Elsevier, vol. 122(6), pages 621-629.
    • Handle: RePEc:eee:hepoli:v:122:y:2018:i:6:p:621-629
    DOI: 10.1016/j.healthpol.2018.04.001
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    References listed on IDEAS

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    2. Krzysztof Goniewicz & Eric Carlström & Attila J. Hertelendy & Frederick M. Burkle & Mariusz Goniewicz & Dorota Lasota & John G. Richmond & Amir Khorram-Manesh, 2021. "Integrated Healthcare and the Dilemma of Public Health Emergencies," Sustainability, MDPI, vol. 13(8), pages 1-13, April.
    3. Matthijs M. Versteegh & Isaac Corro Ramos & Nasuh C. Buyukkaramikli & Amir Ansaripour & Vivian T. Reckers-Droog & Werner B. F. Brouwer, 2019. "Severity-Adjusted Probability of Being Cost Effective," PharmacoEconomics, Springer, vol. 37(9), pages 1155-1163, September.
    4. Niek Stadhouders & Xander Koolman & Christel van Dijk & Patrick Jeurissen & Eddy Adang, 2019. "The marginal benefits of healthcare spending in the Netherlands: Estimating cost‐effectiveness thresholds using a translog production function," Health Economics, John Wiley & Sons, Ltd., vol. 28(11), pages 1331-1344, November.
    5. Fang Wu & Wei Chen & Lingling Lin & Xu Ren & Yingna Qu, 2022. "The Balanced Allocation of Medical and Health Resources in Urban Areas of China from the Perspective of Sustainable Development: A Case Study of Nanjing," Sustainability, MDPI, vol. 14(11), pages 1-28, May.
    6. Sándor Kovács & Bertalan Németh & Dalma Erdősi & Valentin Brodszky & Imre Boncz & Zoltán Kaló & Antal Zemplényi, 2022. "Should Hungary Pay More for a QALY Gain than Higher-Income Western European Countries?," Applied Health Economics and Health Policy, Springer, vol. 20(3), pages 291-303, May.
    7. Al-Janabi, Hareth & Wittenberg, Eve & Donaldson, Cam & Brouwer, Werner, 2022. "The relative value of carer and patient quality of life: A person trade-off (PTO) study," Social Science & Medicine, Elsevier, vol. 292(C).
    8. Werner Brouwer & Pieter Baal & Job Exel & Matthijs Versteegh, 2019. "When is it too expensive? Cost-effectiveness thresholds and health care decision-making," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(2), pages 175-180, March.

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