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Practices of decision making in priority setting and resource allocation: a scoping review and narrative synthesis of existing frameworks


  • Brayan V. Seixas

    (University of California, Los Angeles (UCLA))

  • François Dionne

    (Prioritize Consulting Inc.)

  • Craig Mitton

    (Center for Clinical Epidemiology and Evaluation
    University of British Columbia (UBC))


Background Due to growing expenditures, health systems have been pushed to improve decision-making practices on resource allocation. This study aimed to identify which practices of priority setting and resource allocation (PSRA) have been used in healthcare systems of high-income countries. Methods A scoping literature review (2007–2019) was conducted to map empirical PSRA activities. A two-stage screening process was utilized to identify existing approaches and cluster similar frameworks. That was complemented with a gray literature and horizontal scanning. A narrative synthesis was carried out to make sense of the existing literature and current state of PSRA practices in healthcare. Results One thousand five hundred eighty five references were found in the peer-reviewed literature and 25 papers were selected for full-review. We identified three major types of decision-making framework in PSRA: 1) Program Budgeting and Marginal Analysis (PBMA); 2) Health Technology Assessment (HTA); and 3) Multiple-criteria value assessment. Our narrative synthesis indicates these formal frameworks of priority setting and resource allocation have been mostly implemented in episodic exercises with poor follow-up and evaluation. There seems to be growing interest for explicit robust rationales and ample stakeholder involvement, but that has not been the norm in the process of allocating resources within healthcare systems of high-income countries. Conclusions No single dominate framework for PSRA appeared as the preferred approach across jurisdictions, but common elements exist both in terms of process and structure. Decision-makers worldwide can draw on our work in designing and implementing PSRA processes in their contexts.

Suggested Citation

  • Brayan V. Seixas & François Dionne & Craig Mitton, 2021. "Practices of decision making in priority setting and resource allocation: a scoping review and narrative synthesis of existing frameworks," Health Economics Review, Springer, vol. 11(1), pages 1-11, December.
  • Handle: RePEc:spr:hecrev:v:11:y:2021:i:1:d:10.1186_s13561-020-00300-0
    DOI: 10.1186/s13561-020-00300-0

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    References listed on IDEAS

    1. Goodwin, Elizabeth & Frew, Emma J., 2013. "Using programme budgeting and marginal analysis (PBMA) to set priorities: Reflections from a qualitative assessment in an English Primary Care Trust," Social Science & Medicine, Elsevier, vol. 98(C), pages 162-168.
    2. Gallego, Gisselle & Taylor, Susan Joyce & Brien, Jo-anne Elizabeth, 2007. "Priority setting for high cost medications (HCMs) in public hospitals in Australia: A case study," Health Policy, Elsevier, vol. 84(1), pages 58-66, November.
    3. Fadi Alkaraan, 2018. "Public financial management reform: an ongoing journey towards good governance," Journal of Financial Reporting and Accounting, Emerald Group Publishing, vol. 16(4), pages 585-609, December.
    4. Peacock, Stuart J. & Richardson, Jeff R.J. & Carter, Rob & Edwards, Diana, 2007. "Priority setting in health care using multi-attribute utility theory and programme budgeting and marginal analysis (PBMA)," Social Science & Medicine, Elsevier, vol. 64(4), pages 897-910, February.
    5. Daniels, Norman & Sabin, James E., 2002. "Setting Limits Fairly: Can we learn to share medical resources?," OUP Catalogue, Oxford University Press, number 9780195149364.
    6. Haas, Marion & Viney, Rosalie & Kristensen, Elizabeth & Pain, Charles & Foulds, Kim, 2001. "Using programme budgeting and marginal analysis to assist population based strategic planning for coronary heart disease," Health Policy, Elsevier, vol. 55(3), pages 173-186, March.
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    Blog mentions

    As found by, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 8th March 2021
      by Chris Sampson in The Academic Health Economists' Blog on 2021-03-08 12:00:01

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