Open and Fair — Norwegian Priority-Setting Criteria (NOU 2014:12, Norheim Committee)
This guideline proposes a fair and transparent way to decide which health treatments should get funding in Norway. It focuses on maximizing healthy life years while being fair to people who are worse off. Three main ideas guide decisions: how much health a treatment provides, how costly it is, and how much health a person would lose without it.
At a glance
Use when
Designing national or regional health priority-setting policies; evaluating equity in resource allocation; developing fair and transparent HTA processes.
Avoid when
When only cost-effectiveness (without equity considerations) is required; in settings lacking capacity for equity-adjusted analysis; when political consensus on fairness criteria is absent.
Inputs
Estimates of health benefits (e.g., QALYs), resource costs, and expected lifetime health loss of patients without intervention.
Outputs
Priority ranking of health interventions based on combined criteria of health benefit, cost, and equity (health loss).
How it works
The framework establishes a priority-setting model based on three criteria: health benefit, resource use, and lifetime health loss. It integrates cost-effectiveness analysis with equity considerations by differentiating cost-effectiveness thresholds according to the severity of health loss, thereby giving higher priority to interventions benefiting those with greater expected lifetime health loss. The approach supports open, participatory decision-making processes and aims to institutionalize fairness in resource allocation across the Norwegian health system.
- HTA domains
- Clinical Effectiveness, Costs & Economic Evaluation, Patient and Social Aspects
- Categories
- AppraisalContext & Implementation
- Assumptions
- Health benefits can be measured and compared across conditions; lifetime health loss is a valid equity criterion; societal values support giving priority to the worse off; transparency improves legitimacy.
- Strengths
- Integrates equity explicitly into priority setting; promotes transparency and public trust; provides a structured, ethically grounded decision framework; supports democratic deliberation.
- Limitations
- Operationalizing lifetime health loss can be complex; requires reliable data on long-term outcomes; may face challenges in political implementation; threshold differentiation complicates standardization.
- Also known as
- Norwegian Priority-Setting Criteria, NOU 2014:12, Norheim Committee framework, Open and Fair framework
Questions this answers
- › How can health interventions be prioritized fairly in a publicly funded system?
- › How should equity be integrated into cost-effectiveness analysis?
- › How can societal values be incorporated into health priority setting?
- › How should severity of illness influence priority decisions?
- › What role should transparency and public participation play in health resource allocation?
- › How can cost-effectiveness thresholds be adjusted for fairness?
References & sources
Similar by meaning
Beta record. Based on the original catalogue summary; primary-source enrichment pending.