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Priority setting: learning to make tough decisions

Department of Medicine, University of Cape Town, Observatory, 7925, Cape, South Africa; sbenatar@uctgsh1.uct.ac.za

Keywords: orthostatic hypotension; acetylcholinsterase inhibition; pyridostigmine; priority setting; rationing; resource allocation

The first 150 words of the full text of this article appear below.

Priority setting (also termed resource allocation) for healthcare expenditure is inevitable in all societies, even the most affluent.¹ New technologies are the dominant driving forces.² Although these advances have been successful both in saving lives and in improving quality of life, the costs of trying to provide such modern medical care for all who could potentially benefit exceed the capacity of most countries.

A very considerable proportion of medical expenditure is generated on treating patients during what turns out to be the last year of life.³ It is now increasingly recognised that there are inadequate health returns from such expenditure (both in terms of duration and quality of life) and that there are limits to what medicine should be attempting to achieve.⁴ Consequently there has been a subtle, but largely unacknowledged, shift from a "sanctity of life" approach (in which medical care is continued relentlessly, even when death . . . [Full text of this article]