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It is commonly recognized that the setting of health priorities requires value judgements and that these judgements are social. Justifying social value judgements is an important element in any public justification of how priorities are set. The purpose of this paper is to review a number of social values relating both to the process and content of priority‐setting decisions.

A set of key process and content values basic to health priority setting is outlined, and normative analysis applied to those values to identify their key features, possible interpretations in different cultural and institutional contexts, and interactions with other values.

Process values are found to be closely linked, such that success in increasing, for example, transparency may depend on increasing participation or accountability, and “content” values are found often to be hidden in technical criteria. There is a complex interplay between value and technical components of priority setting, and between process and content values. Levels of economic development, culture and need will all play a part in determining how different systems balance the values in their decisions.

Technical analyses of health priority setting are commonplace, but approaching the issues from the perspective of social values is a more recent approach and one which this paper seeks to refine and develop.

The purpose of this paper is to develop a perspective on what is “salient” or critical to the discipline of healthcare marketing by analyzing and contrasting the consumer (or patient) perspective with the institutional (or organizational) perspective. This “salience issue” is complicated by the structural problems in healthcare such as societal service systems, advances in medical technology, and the escalating costs of care. Reviewing selected studies, the paper examines how consumers face increasingly difficult health choices.

The paper examines the different priorities and goals for marketing that are implied by both patient and organizational perspectives in healthcare, focusing primarily on the excesses of the more “market‐based” US healthcare system.

Healthcare organizations need to better utilize marketing tools to inform consumers and assist their healthcare decisions. This effort needs to be balanced by healthcare organizations that can support the demand to improve quality and increase accessibility of care.

The perspective on the consumer (or patient) often becomes clouded amid the operation of increasingly complex and convoluted healthcare systems. A new perspective on healthcare marketing needs to be considered. Greater consumer access to healthcare information could improve patient decision making. To accomplish this, greater institutional diffusion of evidence‐based healthcare practices is needed to improve organizational performance.

The purpose of this chapter is to describe a method for priority setting that can be used to identify options for disinvestment, and is also meant to serve as a tool for re-allocation of resources to achieve better outcomes with a given pot of resources.

This chapter draws on findings from the application of a priority setting and resource allocation framework known as Program Budgeting and Marginal Analysis (PBMA). Case studies are used to illustrate key points around implementation including factors for success and guidelines for improving priority setting in practice.

PBMA has been applied in over 150 settings over the last 30 years. Purposes varied from focusing strictly on disinvestment to examining opportunities for re-allocation. Many organizations report continued use of the framework and decision makers typically express a desire to not revert to historical allocation or political negotiation in deciding on the funding for programs.

Practical implications of this body of work on priority setting abound in that there are significant opportunities to improve resource allocation practice including better engagement of staff, clinicians and public members, greater use of evidence in decision making and improving process transparency.

As healthcare resources are limited, particularly in predominantly publicly funded health systems, prudent use of resources is critical. Actually applying the appropriate tools to ensure that funding aligns with organizational and system objectives is paramount.

Although there is a large body of literature on priority setting particularly in countries like the United Kingdom and Canada, this chapter serves to highlight key messages specifically in the context of fiscal constraint and in relation to the concept of disinvestment or service reduction.

The purpose of this paper is to identify and describe main obstacles for politicians when dealing with healthcare priority setting.

The study had an exploratory descriptive design based on interviews with 18 politicians from two different county councils in Sweden. The interviews were analyzed using inductive qualitative content analysis.

The politicians highlighted the importance of, and difficulties in, communicate political missions; the politicians in this study saw the media as not always being fair watchdogs, implying that possibly important but unpopular prioritizing decisions were not made because of the risks of being badly reported and therefore not re-elected. Breaking up established structures in care practice is difficult and change takes time, partly because of existing higher level financing and rules and the system’s traditional separation of facilities and services. Although the politicians highlighted their limited power to influence and control resource allocation they could give small and “lower profile”, low-prioritized disciplines control of their own budgets and base payments on the results the disciplines accomplished.

This study highlights the difficulties that politicians experience, for example, having to take unpleasant decisions and thereby run the risk of being scrutinized by media, which in turn could influence how effectively tax money is being used.

The healthcare context is a highly complex one for a variety of reasons. One priority that is, however, firmly established on the agenda for the future is that of patient consultation and involvement in the design and delivery of healthcare services. What is an important next step is to consider ways in which such consultation can be achieved in practice. In order to provide high quality services that represent good value for all concerned, consideration also has to be given to the multiple stakeholder groups that exist in healthcare. The Servqual instrument and the nominal group technique can both provide some useful insights into patient and stakeholder priorities from both the service user and the service provider perspective which can then be incorporated into the service design and the service planning processes.

The outbreak of the COVID-19 pandemic has significantly impacted healthcare systems, presenting unforeseen challenges that necessitated the implementation of change management strategies to adapt to the new contextual conditions. This study aims to analyze organizational changes within the total hip replacement (THR) surgery pathway at multiple levels, including macro, meso and micro. It employs data triangulation from various sources to gauge the complexity of the change process and comprehend how multi-level decision-making influenced an unexpected shift.

A multicentric, single in-depth case study was conducted using a mixed-methods approach. Data sources included patient-reported outcome measures specific to the THR pathway and carefully structured in-depth interviews administered to managers and clinicians in two healthcare organizations serving the same population.

Decisions made at the macro level resulted in an overall reduction in surgical activities. Organizational changes at the meso level led to a complete cessation or partial reorganization of activities. Micro-level actions for change and adaptation revealed diverse and fragmented change management strategies.

Organizations with segmented structures may require a robust and structured department for coordinating change management responses to prevent the entire system from becoming stuck in the absorptive phase of change. However, it is important to recognize that absorptive solutions can serve as a starting point for genuine innovations in change management.

The utilization of data triangulation enables the authors to visualize how specific changes implemented in response to the pandemic have influenced the observed outcomes. From a managerial perspective, it provides insights into how future innovations could be introduced.

The purpose of this paper is to investigate the views of Bulgarian citizens about the relevance of lifestyles in the management of scarce resources through rationing and explore whether they are associated with participants’ characteristics.

A self-administered questionnaire was used to collect data from a sample of 322 Bulgarian respondents. Respondents faced a hypothetical rationing scenario where they have to decide whether information about five harmful health behaviours (smoking, excess alcohol consumption, illegal drug use, overeating/poor diet and engaging in dangerous driving (speeding and/or under the influence of alcohol and/or drugs)) should be relevant in priority setting decisions. Descriptive statistics and logistic regressions were performed.

The majority of respondents disagree with the idea that personal responsibility for illness should count in priority decisions. Notwithstanding, there seems to be a wider consensus in giving lower priorities to patients that engage in dangerous driving (excess of speed and/or under the influence of alcohol and/or drugs), illegal drugs use and excessive alcohol intake. Overeating/poor quality nutrition was the risky behaviour less condemned by respondents followed by smoking. Respondents’ sociodemographic, health and beliefs about rationing criteria had different impact in the penalization of the risk behaviours.

This study is the first attempt to awaken attention to the impact that personal responsibility for health may have on intergenerational access to healthcare.

The purpose of this paper was to explore what kind of ethical competence healthcare managers need in handling conflicts of interest (COI). The aim is also to highlight essential learning processes to develop healthcare managers’ ethical competence.

A qualitative study was performed. Semi-structured interviews with ten Swedish healthcare managers from different care providers were carried out twice and analysed through step-wise categorisation.

Four categories of COI were revealed and two ways (passive and active) in which COI were handled. Ethical guidelines did not help the healthcare managers to handle the COI, and none of the managers made use of any sort of systematic ethical analysis. However, certain ethical competence was of great importance to identify and handle COI, consisting of contextual understanding, rational emotions, some theoretical knowledge and a suitable language. Organising work so that ethical analysis can be carried out is of great importance, and top management needs to clearly express the importance of ethical competence and allocate resources to allow adequate learning processes.

This paper highlights the management level and focuses on how work-integrated learning-processes can enable ethical competence. Ethical competence at the management level is essential both to comply with the constitution and legal requirements regarding healthcare, and so that managers are able to analyse COI and justify their decisions.

Public sector interest in methods for priority setting and program or policy evaluation has grown considerably over the last several decades, given increased expectations for accountable and efficient use of resources and emphasis on evidence‐based decision making as a component of good management practice. While there has been some occasional effort to conduct evaluation of priority setting projects, the literatures around priority setting and evaluation have largely evolved separately. In this paper, the aim is to bring them together.

The contention is that evaluation theory is a means by which evaluators reflect upon what it is they are doing when they do evaluation work. Theories help to organize thinking, sort out relevant from irrelevant information, provide transparent grounds for particular implementation choices, and can help resolve problematic issues which may arise in the conduct of an evaluation project.

A detailed review of three major branches of evaluation theory – methods, utilization, and valuing – identifies how such theories can guide the development of efforts to evaluate priority setting and resource allocation initiatives. Evaluation theories differ in terms of their guiding question, anticipated setting or context, evaluation foci, perspective from which benefits are calculated, and typical methods endorsed.

Choosing a particular theoretical approach will structure the way in which any priority setting process is evaluated. The paper suggests that explicitly considering evaluation theory makes key aspects of the evaluation process more visible to all stakeholders, and can assist in the design of effective evaluation of priority setting processes; this should iteratively serve to improve the understanding of priority setting practices themselves.

The purpose of this study is to explore and compare citizens’ attitudes in Portugal, Bulgaria and Croatia towards rationing criteria that should support an explicit priority setting process at the micro level.

Preferences were collected through an online questionnaire containing 14 statements concerning lottery, economic and person-based priority criteria. Respondents indicated their level of agreement with each criterion. Non-parametric tests were applied to compare the levels of agreement among 355, 298 and 243 Portuguese, Bulgarian and Croatian respondents, respectively.

The three groups of respondents appear to be concerned with both a fair and efficient allocation of resources. The severity of health conditions and patient’s age were the criteria most accepted by the respondents. This study suggests that Portuguese, Bulgarian and Croatian respondents have similar social values concerning patient prioritization, although the Portuguese adhere slightly more to efficiency criteria and less to person-based and lottery criteria than Bulgarian and Croatian respondents.

A majority of respondents across the three countries report having opinion about the bedside rationing criteria. Portuguese, Bulgarian and Croatian respondents accept a combination of personal and economic criteria in patient’s prioritization.

This study represents the first attempt to compare citizen’s opinions of three member states of the European Union.

Research paper