PubMed · 10299174
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H L Smith, R Reid. Improving performance: some practical options.. https://pubmed.ncbi.nlm.nih.gov/10299174/
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India has made great strides in health care since gaining independence in 1947. Much still needs to be done. Scarce health care resources are directed at priorities that include infant and maternal mortality, immunizations, malnutrition, communicable disease prevention, and access to protected water and sanitation. There is, therefore, no government reimbursement for treatment of patients with ESRD (estimated incidence of 100 per million population). Transplantation, the modality of choice in India, benefits only 2-3% of ESRD patients. Hemodialysis is primarily used short-term for pretransplant stabilization. A very small minority of patients is placed on maintenance hemodialysis or CAPD. The annual cost of renal replacement therapies is more than 10 times the per capita gross national product. Financial constraints pose ethical problems for the nephrologist related to adequate prescriptions and compliance. Preventing the progression of kidney disease and reducing the cost of disposables through indigenous manufacture are initiatives that need to be explored.
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OBJECTIVE: To describe priority setting for new technologies in medicine. DESIGN: Qualitative study using case studies and grounded theory. SETTING: Two committees advising on priorities for new technologies in cancer and cardiac care in Ontario, Canada. PARTICIPANTS: The two committees and their 26 members. MAIN OUTCOME MEASURES: Accounts of priority setting decision making gathered by reviewing documents, interviewing members, and observing meetings. RESULTS: Six interrelated domains were identified for priority setting for new technologies in medicine: the institutions in which the decision are made, the people who make the decisions, the factors they consider, the reasons for the decisions, the process of decision making, and the appeals mechanism for challenging the decisions. CONCLUSION: These domains constitute a model of priority setting for new technologies in medicine. The next step will be to harmonise this description of how priority setting decisions are made with ethical accounts of how they should be made.