Making difficult budget decisions


Principle 1: Maximize Health The goal of health care is to maximize the public’s health using the available resources. — This goal should take into account the wider public’s health, not just particular patient groups that an individual hospital or physician sees. — Consider the severity of the condition. — Consider the greatest good to the greatest number. Principle 2: Cost Consider the role that cost plays in the various procedures/treatments. — Compare the costs of a variety of procedures. Is there evidence that one treatment can yield more procedures or a larger benefit to the population than another treatment? Principle 3: Benefits and Harms The magnitude of benefits and harms should be applied in a way that maximizes the greatest good for the greatest number. — Is there evidence that the procedure is effective in improving health outcomes? — Are the net benefits of the procedure greater than the net harms, or the harms of doing nothing? — Compared with alternatives, is the procedure cost-benefit effective? (For ex. Prioritize aspirin over surgery for pain where possible.) Principle 4: Cost-Benefit Considerations Looking at cost or benefit alone is not enough—one must compare to see how to receive the greatest good from the potential available resources. — Is the procedure cost-benefit effective? In other words, is it the greatest benefit for the least cost (for ex. Prioritize aspirin over surgery for pain where possible)? — Are there alternatives to the procedure that can provide equal or somewhat equal benefits at less cost? Principle 5: Patient Preferences While decisions about resource constraints must be made at the population level, they should consider the needs and wishes of patients. — What might the patients’ preferences be with respect to how to allocate resources? Citations Eddy, D. M. (1994). Principles for making difficult decisions in difficult times. JAMA, 271(22), 1792-98.

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