Making Defensible Decisions About Resource Allocation
The Challenge of Choosing
Every public healthcare agency faces the same fundamental challenge: unlimited needs, limited resources. Should you invest in diabetes prevention or substance use treatment? Maternal health programs or chronic disease management? School-based clinics or mobile health units?
These aren't just budget decisions—they're decisions that affect entire communities. The programs you choose determine which health problems get addressed, which populations receive services, and ultimately, who benefits from public investment.
Without a transparent, defensible process for making these choices, agencies risk:
Decisions driven by politics rather than evidence
Resource allocation that doesn't match actual community needs
Loss of public trust when stakeholders don't understand why programs were or weren't selected
Difficulty justifying decisions to boards, funders, and communities
Inconsistent decision-making as leadership or priorities shift
Why Economic Frameworks Matter for Priority-Setting
From an economic perspective, priority-setting is fundamentally about allocative efficiency—getting the maximum health benefit from limited resources. But it's also about legitimacy and trust—ensuring that decisions are fair, transparent, and defensible to all stakeholders.
Traditional approaches to priority-setting often rely on:
Historical budgets ("we've always funded this")
Political pressure ("the board wants this")
Loudest voices ("this group advocated most strongly")
Crisis response ("we need to address this emergency")
While these factors may have some validity, they don't provide a systematic framework for making trade-offs or explaining why one program deserves funding over another.
Health economics provides structured approaches that:
Make decision criteria explicit and transparent
Balance multiple considerations (health impact, equity, feasibility, cost)
Document the rationale behind every decision
Enable stakeholders to understand trade-offs
Create consistency across decision cycles
Build public trust through demonstrated fairness
What Makes Priority-Setting Transparent
Transparency in priority-setting means that stakeholders can understand:
What criteria
were used to evaluate programs
How criteria were weighted
(which factors mattered most)
Who participated
in the decision process
What evidence
informed the decision
Why
certain programs were selected over others
How
the process can be improved for next time
This doesn't mean everyone will agree with the final priorities—but it means they can see that the process was fair, evidence-based, and respectful of diverse perspectives.
Our Approach: Multi-Criteria Decision Analysis (MCDA)
We use multi-criteria decision analysis frameworks adapted specifically for public health priority-setting. MCDA is a structured methodology that:
Identifies relevant decision criteria based on community values and organizational goals
Establishes weights for each criterion reflecting their relative importance
Scores each option (program, intervention, policy) against all criteria
Calculates overall priorities combining scores and weights
Tests sensitivity to see how different assumptions affect rankings
Documents the entire process for transparency and accountability
This approach has been used successfully by health systems worldwide and is recommended by organizations including the World Health Organization for resource allocation decisions.
Common criteria we help agencies develop include :
Health Impact
& Burden
Disease burden (morbidity, mortality, economic cost)
Potential health improvement from intervention
Population reach and scale of impact
Equity & Social Justice
Impact on health disparities
Service to vulnerable or underserved populations
Geographic equity (urban vs. rural access)
Economic Considerations
Cost-effectiveness (health gained per dollar spent)
Return on investment
Budget impact and sustainability
Cost to community if problem unaddressed
Feasibility & Capacity
Organizational capacity to deliver
Community readiness and acceptance
Implementation timeline
Availability of evidence-based interventions
Strategic Alignment
Fit with agency mission and mandate
Alignment with state/federal priorities
Opportunities for partnership and leverage
Long-term strategic value
Community Priorities
Community-identified needs
Stakeholder input and preferences
Political and social context
