Background Priority setting involves the practice of ranking interventions in order of their importance. In principle, the same priority setting criteria may be used across all levels of decision-making in health care. This may include decision-making on the macro (cabinet and the health ministry), meso (resource allocation within hospitals and health trusts) and micro level (bedside rationing).
Objective The aim of this article is to present a systematic discussion of priority setting across different levels of decision-making. Should different criteria for priority setting apply at the different levels? How can we decide which criteria fall into which category? And what should count as a sufficient argument for having different principles at different levels?
Methods We present the current literature on the topic through a scoping review. We expand on the literature to suggest useful definitions of levels of priority setting and candidate reasons for significant differences between the levels.
Results We found that definitions and the suggested number of levels differ, but the most favoured approach was two or three levels of priority setting. We present descriptive differences between the levels and suggest what we believe are useful definitions of levels of priority setting. We further present and discuss candidate reasons for ethically significant differences between the levels with applications for priority setting.
Discussion We consider this article to be a first step towards a more rigorous approach to priority setting across levels of decision-making in health care. We recommend that the levels of priority setting are more consistently and comprehensively defined. We argue in favour of further systematic discussion of this topic in future and conclude that this topic should be unavoidable in further discussions.
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