Proportional shortfall in Dutch priority setting (review)
This review looks at how Proportional Shortfall (PS) has been used in the Netherlands to help decide which healthcare services should get funding when budgets are limited. PS measures how far a health condition is from an ideal level of health, aiming to balance fairness and efficiency. The method has been increasingly used since 2015, especially in advice given by the Dutch appraisal committee, but there is still no full agreement on how to apply it, and evidence supporting it is limited.
At a glance
Use when
Deciding on healthcare funding priorities where equity and efficiency must be balanced; evaluating necessity of care in a standardized way across sectors
Avoid when
When robust empirical validation is required; when detailed age-specific or lifetime health inequality considerations are central to decision-making
Inputs
Health outcome data, reference health levels, cost-effectiveness ratios, societal preference indicators
Outputs
Quantified necessity scores, input for priority-setting decisions, equity-adjusted cost-effectiveness assessments
How it works
Proportional shortfall (PS) is a method used to quantify the necessity of care by measuring the gap between current health outcomes and a reference level of health, enabling an equity-efficiency trade-off. This review analyzes the theoretical and empirical basis of PS, its integration into Dutch healthcare priority setting via the Adviescommissie Pakket (ACP), and its role in decision-making frameworks. While PS supports a uniform cost-effectiveness evaluation model using monetary reference values, its operationalization lacks robust empirical validation and may not fully capture societal preferences related to age or lifetime health inequality.
- HTA domains
- Clinical Effectiveness, Costs & Economic Evaluation, Patient and Social Aspects
- Assumptions
- Health equity can be operationalized through measurable shortfall from a health reference; decision-makers value proportionality in unmet health needs; monetary thresholds reflect societal willingness-to-pay for necessity reduction
- Strengths
- Provides a structured framework for equity-efficiency trade-offs; enables uniform priority setting across healthcare sectors; incorporates measurable necessity into decision-making
- Limitations
- Limited empirical validation; may not adequately reflect societal preferences on age or lifetime health inequality; lack of consensus on implementation
- Also known as
- Proportional shortfall, PS, Necessity-based priority setting (Dutch context)
Questions this answers
- › How is necessity of care quantified in Dutch healthcare priority setting?
- › What role does proportional shortfall play in equity-efficiency trade-offs?
- › How has PS been applied in decisions by the Dutch Adviescommissie Pakket (ACP)?
- › What are the theoretical and empirical foundations of PS?
- › What are the limitations of PS in reflecting societal values?
- › Is there consensus on the use of PS in healthcare decision-making in the Netherlands?
References & sources
Similar by meaning
Beta record. Generated from the primary source via AI extraction and independent audit, pending final human review.