Abstract
With increasing demand and limited supply of healthcare resources, healthcare systems depend on priority-setting frameworks to guide resource allocation. The principles underlying these frameworks are the topic of ongoing debate in the academic literature, in policy, and in the public discourse. One of these principles is ‘severity’. Applied as a priority-setting criterion in Norway, Sweden, the Netherlands, and the United Kingdom, severity is intended to modify cost-effectiveness analyses to ensure that treatment for severe illnesses may be provided despite not necessarily meeting conventional cost-effectiveness thresholds. However, there is no consensus on exactly what ‘severity’ means. The aim of this thesis is to address the knowledge gap surrounding public views on the meaning of severity, within the context of medical ethics and priority setting.
The thesis comprises three studies. The first qualitatively explores public views on severity via thematic analysis of group interviews transcripts. The second identifies general viewpoints on severity, by building on data from the group interviews and conducting a second round of data collection applying Q methodology. The third examines the distribution of those viewpoints in a representative sample of the Norwegian population, also using Q methodological methods.
Overall, the findings presented in this thesis suggest there are multiple different views held by members of the public on the meaning of severity, many of which appear to represent additional concerns to those represented in policy operationalisations of severity. The thesis considers potential policy implications of this plurality of views, the role of public views and how this plurality might be addressed in policy. Finally, it highlights the challenge facing policymakers with such a misalignment between public views and policy.