This press release summarizes findings from a report generated by a team of economists that advances a reserve system approach to incorporating competing ethical principles for rationing scarce resources in response to a public health emergency.

Most resource allocation guidelines rely on either a single prioritization scheme, such as a point system based on likelihood of survival with treatment. Some apply priority systems in series, for example first using a point system and then prioritizing by another factor for patients with the same scores, for example favoring health care workers or younger patients to break ties.

The proposed reserve system, in contrast, categorizes patients into multiple groups (such as young or old, health care worker or not, sick or very sick) and sets specific quantities of resources reserved for each group. Within each group, resources can be allocated by a scoring system or random assignment. According to the report’s authors, such a system provides more flexibility because it does not require a single prioritization system be applied to the entire stock of resources. The authors argue that this allows multiple interests and ethical principles to be served simultaneously and reduce the potential that a single principle dominates others, but they caution that transparency and careful implementation are essential, particularly with respect to the processing order of each category. The draft report is available here.