The 'Holy Grail' of healthcare: fair resource allocation

Allocating public healthcare funds on the basis of individual-specific cost-effectiveness analyses and quality-of-life measures is an 'equitably efficient' and 'transparently decidable' way to spend the public health purse, says Jack Dowie from The Open University, Milton Keynes, UK. That is, allocating funds in this way would allow a trade-off between equity and efficiency, and would require decisions to be made using a balance of intuition and analysis.

Moreover, allocating public health money on an individual basis would eliminate most intermediate levels of healthcare decision-making, thereby saving 'a colossal amount of administrative ('bureaucratic') costs' .

Socio-political decisions Patient-specific healthcare evaluations that take

into account altruistic and equity concerns should be used to determine how much public money any individual will receive for any healthcare intervention, according to Mr Dowie. Each evaluation should consider the following socio-political decisions: • the monetary value to be accorded to an expected life·year • the rate of discounting over time to be used • the maximum willingness to pay by society per incremental

expected quality-adjusted life-year.

Also, it would be necessary to establish a rule that determines which healthcare options will be fully funded and the degree to which other options will be funded.

All other healthcare decisions would be clinical and would therefore be made at the individual patient level. These decisions are assumed to be based on 'selfish' preferences, notes Mr Dowie.

Oinical decisions Two evaluations would be conducted for every

clinical decision: • a 'private' evaluation of each patient's personal preference

for therapy, irrespective of outside factors

• a 'publiC evaluation that determines whether the privately preferred option will be fully funded by the public coffers, and, if not, what proportion of its cost will be funded.

Dowie 1. Towards the equitably efficient and transparently decidable use of public funds in the deep blue millennium. Health Economics 7: 93-103. Mar 1998 _00

PharmacoEconomics & Outl::omes News 16 May 1998 No. 162 1173-550319810162-00021$01.00° Ad is International Limited 1998. All rights reserved