Social values and health priority-setting
Co-Investigators: Dr Katharina Kieslich (KCL), Prof Peter Littlejohns (KCL), Dr Annette Rid (KCL), Dr Benedict Rumbold (UCL), Prof Albert Weale (UCL), Dr James Wilson (UCL)
About the research: All health care systems are facing the challenge of ensuring that high quality care is provided to the maximum number of people at a cost that the country can afford. This comes at a time when people are living longer, have increasing expectations of what care should be provided, and when the speed of health care innovation continues to offer ever greater options for intervention. Because no country can afford to provide all its residents with every medical intervention regardless of cost or amount of clinical benefit, all political systems are facing the problem of how to set priorities in the allocation of health care resources. It has long been acknowledged in many countries that technical criteria such as cost and clinical effectiveness inform decisions about resource allocation. However, as well as technical evaluations, priority setting decisions increasingly involve social value judgments – that is, judgments made on the basis of the moral or ethical values of any particular society. Values such as justice, equity, dignity, non-discrimination, autonomy, and solidarity figure prominently in debates about priority setting. The way in which these values are weighed in decision making varies widely between different countries, but policy makers the world over increasingly must grapple with the problem of how to strike a balance between the values in a way that is socially and ethically justifiable. Our research objectives are as follows: 1) To undertake a cross-national exploration of the different ways in which values are constructed or understood and for what reasons; 2) To identify cross-nationally how social values are incorporated into decisions about healthcare resource allocation; 3) To assess similarities and differences in the shape and expression of social values, whether or how they are assessed, their political context, and the degree of consensus and diversity within each national setting in different countries across the world; 4) To consider diversity and disagreement about values within countries as well as cross-nationally and in particular, how different countries approach or understand pluralities of value sets within their own population, as these relate to priority setting and as they reflect minority or ethnic group differences within countries.
Littlejohns P, Weale A, Kieslich K, Wilson J, Rumbold B, Rid A: Two Steps Forward, One Step Back? Scientific, policy and ethical challenges in the proposed revamp of the Cancer Drugs Fund. Lancet Oncology (forthcoming)
Rumbold B, Weale A, Rid A, Wilson J, Littlejohns P: Public Reasoning and Health Care Priority Setting: The Case of NICE. Kennedy Institute of Ethics Journal (forthcoming)
Rid A, Littlejohns P, Wilson J, Rumbold B, Kieslich K, Weale A (2015): The importance of being NICE. Journal of the Royal Society of Medicine 108(10): 385-389
Numerous submissions to public consultations and workshops. For more information, please see: www.ucl.ac.uk/socialvalues/about