Priority Setting in Norwegian Hospitals – An Overview of Available Research

Background: Even in wealthy Norway, there is a mismatch between medical need and the resources at hand given an aging population and technological advancements: priorities need to be made. Priority setting decisions occur at many levels of the healthcare system, and many resource allocation decisions are made by hospital leaders. The meso-level refers to healthcare service management at referral institutions, distinct from macro-level policymaking and micro-level clinical decisions. Aim: The process of setting priorities in the hospital setting remains unclear and insufficiently investigated. This review aims at making an overview of available research on priority setting at the meso-level. Method: We conducted a scoping review to gather data from research on priority setting and decision making in Norwegian hospitals. Our methodology followed PRISMA-scoping review principles, including a systematic literature search of the databases PubMed, Idunn, WoS, and CINAHL, and a manual search of reference lists. We included 11 empirical studies, covering various research objectives and domains, such as nursing ethics and costing analysis tool evaluation. Results: Using the Walt and Gilson policy analysis framework, we identified key elements of priority setting: content, context, process, and actors. Our analysis revealed a lack of empirical findings on the process domain. Conclusion: Scientific knowledge about priority setting remains centred around the content of policies, particularly criteria and guidelines. The focus on content overshadows procedural aspects within the policy analysis triangle. Understanding the processes of priority setting is crucial for the legitimacy of the public sector in a democratic welfare state.