The FSS Prioritization Process is based on key concepts from the fields of ethics and economics related to the allocation of scare resources. From the field of ethics, we know that in order for people to accept outcomes as reasonable, they must find the process leading to these outcomes to be fair. Fair processes are generally objective, transparent and systematic. From the field of economics, we know that resource allocation should be based on a marginal analysis and account for opportunity costs.
Program Budgeting and Marginal Analysis (PBMA), an economic approach to prioritizing resources, embodies these important characteristics. With this approach, each suggested solution is rated against a defined set of pre-weighted criteria, allowing for objective comparisons. This process is a stark contrast to more traditional and common decision-making processes, which are typically influenced by historical patterns or conflicts of interest and often result in a suboptimal use of resources. PBMA has been successfully used throughout the world for nearly four decades in many sectors, including health care and public health, and provides the framework for the FSS Prioritization Process.
When allocating resources, PBMA considers marginal analysis and opportunity costs. Marginal analysis is about how changes, for example the expansion of a program or the creation of a new program, impact total benefit. In line with this principle, PBMA starts with understanding the community as it is now (the current needs and services in the community – step 1 of the process) and attempts to estimate how much benefit any change to the current situation would produce (steps 3 and 4 of the process).
Considering opportunity cost means that a decision to invest in any given possible change cannot be made in a vacuum, based only on the expected costs and benefits of that change. This is because by choosing one action, you will not be able to allocate those resources to other actions – i.e., you lose the opportunity to create benefits from the alternate options. Therefore, to make the right decisions about how to allocate resources, the value of each change under consideration must be estimated in a systematic way (step 3 of the process) that allows a fair comparison across all the possible changes (step 4 of the process) in any given setting.
Source: Mitton C, Donaldson C. Health care priority setting: principles, practices and challenges. Cost Eff Resour Alloc. 2004;2(1):3.