Download eBook for Free

FormatFile SizeNotes
PDF file 1.6 MB

Use Adobe Acrobat Reader version 10 or higher for the best experience.

Research Question

  1. What procedural, ethical, and clinical inputs are required elements for high-quality decisions about allocation of scarce resources in a pandemic?

In the COVID-19 pandemic, many health system and state policymakers are working with no established methods for making decisions about allocation of scarce but lifesaving health care resources for patients and personal protective equipment for health care and long-term care workers. In many settings, decisions are being made ad hoc, with limited information and no input from patients and families, and criteria for allocation of scarce medical resources are not settled.

Recognizing that these challenges threaten the quality of health care resource allocation decisions, the authors created a rapid response guidance checklist to support health care resource allocation decisionmaking during the COVID-19 crisis. The Core Guidance Checklist was created from a consensus discussion process with bioethicists, health system leaders, clinicians, patient advocates, and representatives of affected communities. It is intended for use by decisionmakers within health systems, as well as state-level policymakers, to strengthen resource allocation policy development and implementation and improve the decisions that result. The Core Guidance Checklist can be used to guide evaluation of allocation guidance policy, both the content and the consequent decisionmaking, to spur improvements and to increase public trust.

Key Findings

A consensus discussion process with clinicians, health system leaders, bioethicists, and others identified core elements of sound resource allocation decisionmaking under conditions of scarcity.

  • These elements include use of clinical criteria to establish short-term prognosis, and they include reference to basic issues of distributive justice and fairness within society.
  • Consistent application of the clinical and ethical criteria are core elements for improving decisionmaking.
  • Ensuring that representatives from impacted groups, including patients, family members, advocates and members of disproportionately affected communities, and individuals who are at risk of infection are involved in communication about the policy addresses the need to establish and maintain public trust.
  • While specific elements of clinical and ethical criteria can be standardized across health systems, context-sensitive requirements will shape local adaptation.
  • Health care resource allocation policies require inputs of current information, at regular intervals, to be responsive to changing clinical knowledge and evolving knowledge of the impact of the pandemic across different populations.
  • The authors' Core Guidance Checklist is designed to ensure that health system policy and allocation decisions are clear, consistent, current, collaborative, and context-sensitive.

Research conducted by

Funding for this research was provided by gifts from RAND supporters and income from operations. The research was conducted by the Quality Measurement and Improvement Program within RAND Health Care.

This report is part of the RAND research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited; linking directly to this product page is encouraged. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial purposes. For information on reprint and reuse permissions, please visit

RAND is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.