Priority setting for environmentally sustainable health care: emerging approaches to fair resource allocation

Priority setting in health care is a research and practice area at the intersection of medicine, ethics, and economics, which aims to systematically and transparently evaluate the value for money of health services to support fair resource allocation. Three widely accepted principles for fair priority setting are cost-effectiveness, priority to the worse off, and financial risk protection, with a wide range of other contested criteria. Conceptualising and navigating potential synergies and trade-offs between competing goals, and clearly communicating the values at stake, are the central tasks of priority setting. It is now increasingly clear that health care systems have substantial environmental effects that have been largely overlooked, and that the growing movement towards high-quality, low-polluting, and climate-resilient health systems has potentially far-reaching implications for resource allocation. This Personal View explores how priority setting tools can facilitate the transition to environmentally sustainable health care. We outline the key principles of priority setting in health care and explore how environmental sustainability can be incorporated into resource allocation tools, such as health technology assessment and multicriteria decision analysis, as well as budgetary processes, such as programme budgeting and marginal analysis. We conclude with some implications for wider health system transformation.