Georg Mathias Honoré Barra

• Hol, Bjørn Ottar; Barra, Mathias & Solberg, Carl Tollef (2026). Public Opinion on Organ Conscription and Free Riding: Results from a Norwegian Survey. Etikk i praksis. ISSN 1890-3991. 20(1), p. 9–22. doi: 10.5324/eip.v20i1.6603. Full text in Research Archive Show summary

  Shortage of organs for transplantation leads to reduced quality of life and premature deaths among patients on waiting lists. One proposed policy response is the conscription of cadaveric organs, whereby all suitable organs are retrieved after death. Another proposal is to restrict access to transplantation for patients who have not themselves consented to donate. The ethical acceptability of both policies remains contested, and empirical evidence on public opinion is limited. Previous surveys suggest low support for conscription. We conducted a national survey of adults in Norway (N = 1000) to investigate public attitudes towards the badness of death (reported elsewhere), the conscription of organs for transplantation, and reciprocity, understood as the acceptance to be a potential donor as necessary for being a potential recipient of organs if in need. This last question did not elicit conclusive responses. It did, however, show a correlation between responses supportive of reciprocity (i.e., against free riding) and those supportive of conscription. The results suggest a slight majority in favor of conscription in Norway. Our survey shows that belief in an afterlife corresponds negatively with acceptance of conscription, but no other demographic data are influential.

• Torjusen, Marius Lamberg; Rand, Kim; Whitehurst, David G.T.; Stavem, Knut & Barra, Mathias (2025). Is There a General Preference for the Worse Off? A Discrete Choice Experiment Using Individually Calibrated Health State Valuations. Value in Health. ISSN 1098-3015. 28(9), p. 1390–1398. doi: 10.1016/j.jval.2025.05.017. Full text in Research Archive Show summary

  Objectives We aimed to develop and demonstrate a method for examining public preferences for priority setting in healthcare, using EQ-5D-5L health states valued at an individual level. We examine the Norwegian population’s preferences for prioritizing the “worse off” in terms of health at a cost to health maximization. This intuition is a part of healthcare priority setting frameworks in several countries. Preference studies help explore the legitimacy of such policies, but most studies do not use individual-level health state values, which may distort their conclusions. Methods Task-based face-to-face interviews were conducted in the Norwegian general population. First, respondents valued a set of EQ-5D-5L health states using time trade-off. Second, discrete choice tasks were administered, describing health state improvements that contrasted utility maximization and benefit to the worse off, according to each respondent’s valuation. Analysis used mixed-effects models with choice and respondent properties. Results We conducted 606 interviews, of which 468 respondents were included in the priority setting exercise. Respondents’ choices were influenced by the size of the health improvement, but not by an option being worse in terms of a lower pretreatment health state value. Choice behavior was influenced by respondents’ gender, religion, and age. On average, the choices indicate a preference for prioritizing the better off. Conclusions Our two-stage design using individual health state values is feasible, although there are trade-offs and room for development with such a design. We found no support for a preference for prioritizing the worse off when using individual-level health state valuations.

• Horn, Sindre August; Norheim, Ole Frithjof & Barra, Mathias (2025). Inequality aversion in health: Eliciting aversion to univariate health inequalities across different health distributions. Value in Health. ISSN 1098-3015. 28(12), p. 1890–1899. doi: 10.1016/j.jval.2025.07.014. Full text in Research Archive
• Horn, Sindre August; Norheim, Ole Frithjof & Barra, Georg Mathias Honoré (2024). An Alternative Approach to Measuring Health Inequality in Norway and Implications for Municipal Priority Setting. Tidsskrift for omsorgsforskning. ISSN 2387-5976. 10(2), p. 65–89. doi: 10.18261/tfo.10.2.6. Full text in Research Archive Show summary

  Background: The health state of a population can be measured in different ways. Common measures are life expectancy at birth or quality-adjusted life expectancy. However, the distribution of health may also be of interest to inform priority setting in health. Whereas there is a growing literature on the social distribution of health, knowledge of pure health inequalities may be useful to inform fair and equitable priority setting in both specialist and municipal health services. Method: We aimed to investigate the distribution of life years and quality-adjusted life years in Norway using recent mortality tables and population norms for health-related quality of life at different ages. We propose and contrast two alternative methods for estimating what we term expected quality-adjusted lifespans – the amount of quality-adjusted life years an individual who dies at a certain age will have achieved through their life. The first method assumes a relationship between increasing chronological age and decreasing health-related quality of life, and the second assumes that decreasing health-related quality of life is correlated with shorter remaining lifespan (time-to-death). The first method is similar to established methods to estimate quality-adjusted life expectancy, whereas the second is a novel approach. We estimate average, expected quality-adjusted lifespans in quintiles across a cohort of newborns in Norway in 2022. We further provide quality-adjusted life expectancies by age and sex. Results: Our results show that the gap in unweighted lifespans between individuals in the highest and lowest quintile is more than 30 years, whereas the gap in expected quality-adjusted lifespans is between 25 and 27 quality-adjusted life years, depending on the method used. We find that the time-to-death model yields lower estimates of expected quality-adjusted lifespans in the lower end of the distribution and higher estimates in the higher end, and thus higher inequality, compared to the chronological age model. Conclusion: Our estimates show that the expected distribution of both unweighted and quality-adjusted lifespans in Norway is uneven. While our results may be of relevance across all levels of priority setting in health, we argue that our study may be of particular interest to policy makers who wish to take distributive effects of priority setting in the municipal health sector into account. We argue that priority setting in the municipal health services should give higher priority to individuals and groups who are at risk of falling into the lower end of the expected quality-adjusted lifespan distribution. Examples include addiction and mental illness, severe disability, and chronic illness with early onset. We invite future research on this topic.

• Jølstad, Odd Borgar; Stenmarck, Mille Sofie & Barra, Mathias (2024). Preparing popular views for inclusion in a reflective equilibrium: A case study on illness severity. Social Science and Medicine. ISSN 0277-9536. 348. doi: 10.1016/j.socscimed.2024.116794. Full text in Research Archive
• Jølstad, Odd Borgar; Juth, Niklas; Solberg, Carl Tollef & Barra, Mathias (2024). When Should Popular Views be Included in a Reflective Equilibrium? Erkenntnis: An International Journal of Scientific Philosophy. ISSN 0165-0106. doi: 10.1007/s10670-024-00805-8. Full text in Research Archive Show summary

  It has become increasingly common to conduct research on popular views on ethi- cal questions. In this paper, we discuss when and to what extent popular views should be included in a reflective equilibrium process, thereby influencing norma- tive theory. We argue that popular views are suitable for inclusion in a reflective equilibrium if they approximate considered judgments and examine some factors that plausibly contribute to the consideredness of popular views. We conclude that deliberation and familiarity contribute to the consideredness of popular views, whereas prevalence does not. Furthermore, we raise the “fair trial” objection: that expert deliberation on popular views might fail to respect the consideredness of these views. Eliciting views approximating considered judgments directly from par- ticipants is therefore preferable to refining popular views or treating them as “bare” intuitions in the reflective process. These conclusions have important implications for which research methods will likely elicit popular views suitable for a reflective equilibrium process. Research focusing on the prevalence of views is unlikely to yield popular views suitable for a reflective equilibrium, whereas deliberative and in-depth work is more promising.

• Sørheim, Preben; Barra, Mathias; Norheim, Ole Frithjof; Gamlund, Espen & Solberg, Carl Tollef (2024). Premature Death as a Normative Concept. Health Care Analysis. ISSN 1065-3058. 32(2), p. 88–105. doi: 10.1007/s10728-023-00471-x. Full text in Research Archive Show summary

  The practical goal of preventing premature death seems uncontroversial. But the term ‘premature death’ is vague with several, sometimes conflicting definitions. This ambiguity results in several conceptions with which not all will agree. Moreover, the normative rationale behind the goal of preventing premature deaths is masked by the operational definition of existing measures. In this article, we argue that ‘prema- ture death’ should be recognized as a normative concept. We propose that normative theories should be used to justify measures of premature death to provide them with normative validity and public legitimacy.

• Torjusen, Marius Lamberg; Feiring, Eli; Barra, Mathias; Vøllestad, Nina Køpke & Solberg, Carl Tollef (2024). Priority Setting in Norwegian Municipal and Health Care Services: A Thematic Analysis of Public Consultation Documents. Tidsskrift for omsorgsforskning. ISSN 2387-5976. 10(2), p. 124–137. doi: 10.18261/tfo.10.2.9. Full text in Research Archive Show summary

  Despite Norway’s long history of open priority setting in healthcare, formal priority setting in municipal health and care services had been lacking prior to the publication of a Norwegian official report (English: Green paper, Norwegian: NOU) on the topic in 2018 (the Blankholm report). This article examines the reception of the report’s proposals from different stakeholders. Methods: We analysed 123 public consultation documents on the Blankholm report using a combined deductive and inductive thematic analysis. The consultation bodies represented the views of stakeholders, including patient and professional organisations, directorates, academic institutions, hospitals, and municipalities. Results: Our analysis resulted in two main themes: 1) Concerns about whether the proposed criteria are fit for purpose and 2) Concerns about infringing upon the principle of municipal autonomy and scepticism regarding whether the proposed priority setting process will enhance municipal services. Conclusion: Although there is acceptance for the necessity of priority setting, several issues remain. These issues relate to the proposals' lack of definition, the complexity of municipal health and care services, and a distrust between municipalities and the central government.

• Stenmarck, Mille Sofie; Whitehurst, David GT.; Baker, Rachel & Barra, Mathias (2024). Charting public views on the meaning of illness severity. Social Science and Medicine. ISSN 0277-9536. 347. doi: 10.1016/j.socscimed.2024.116760. Full text in Research Archive Show summary

  Background Illness severity is a central principle in multiple priority-setting frameworks, yet there is a paucity of research on public views regarding the meaning of illness severity. This study builds on the findings of a Q methodology study with members of the public that identified four general viewpoints on the meaning of illness severity. Here, we investigate the support for those viewpoints among the Norwegian population. Methods Following piloting, the online survey was distributed to a broadly representative sample of the population (March to April 2023). The viewpoints from the earlier Q study were converted into vignettes: Lifespan, Subjective, Objective, and Functioning and Quality of Life (FQoL). The main task in the survey comprised ranking the vignettes and scoring them on a 0–10 visual analogue scale. We describe vignette alignment (from weak to strong) based on four categorisations (C1 to C4). C1 placed all respondents on their top scored vignette(s); C2 required a score of ≥7; C3 was designed to resolve ties; and C4 (which describes vignette membership) required a score of ≥7, a gap of two between vignettes scored ≥7, and did not allow ties. Results The survey was completed by 1174 individuals; those who completed in ≤3.5 min were excluded. Of the final sample (n = 1094), 98.1% scored at least one vignette ≥7. In C1, 40.2% were aligned with Lifespan, 32.4% with FQoL, 28.9% with Objective, and 16.3% with Subjective. Using the C4 criteria, 55.4% did not have vignette membership, 13.6% had membership with Lifespan, 13.1% with Objective, 11.4% with FQoL, and 6.5% with Subjective. Conclusions Severity is an ambiguous term among members of the public. Decisionmakers ought to bear this plurality of meanings in mind, and perhaps reconsider whether using a term as multifaceted as ‘severity’ is helpful in formulating precise and transparent priority-setting criteria.

• Stenmarck, Mille Sofie; Jølstad, Odd Borgar; Baker, Rachel; Whitehurst, David GT. & Barra, Mathias (2023). A severely fragmented concept: Uncovering citizens’ subjective accounts of severity of illness. Social Science and Medicine. ISSN 0277-9536. 330. doi: 10.1016/j.socscimed.2023.116046. Full text in Research Archive
• Solberg, Carl Tollef; Barra, Georg Mathias Honoré; Sandman, Lars & Hofmann, Bjørn Morten (2023). Severity as a moral qualifier of malady. BMC Medical Ethics. 24(1), p. e1–e7. doi: 10.1186/s12910-023-00903-2. Full text in Research Archive Show summary

  The overarching aim of this article is to scrutinize how severity can work as a qualifier for the moral impetus of malady. While there is agreement that malady is of negative value, there is disagreement about precisely how this is so. Nevertheless, alleviating disease, injury, and associated suffering is almost universally considered good. Furthermore, the strength of a diseased person's moral claims for our attention and efforts will inevitably vary. This article starts by reflecting on what kind of moral impetus malady incites. We then analyze how severity may qualify this impetus. We do so by discussing the relationship between severity and need, well-being and disvalue, death, urgency, rule of rescue, and distributive justice. We then summarize our thoughts about severity as a moral qualifier. We conclude that severity is, and should continue to be seen, as a morally significant concept that deserves continued attention in the future.

• Kliem, Elisabeth; Labberton, Angela Susan; Barra, Mathias; Olsen, Alexander; Thommessen, Bente & Thomas, Owen Matthew Truscott [Show all 9 contributors for this article] (2022). Self-reported cognitive and psychiatric symptoms at 3 months predict single-item measures of fatigue and daytime sleep 12 months after ischemic stroke. Frontiers in Neurology. 13. doi: 10.3389/fneur.2022.944586. Full text in Research Archive Show summary

  Introduction: Post-stroke fatigue and increased need for daytime sleep are multidimensional and insufficiently understood sequelae. Our aim was to study the relationships of self-reported cognitive and psychiatric symptoms at 3 months with fatigue and daytime sleep at 12 months post-stroke. Methods: Ischemic stroke patients without reported history of dementia or depression completed postal surveys 3- and 12-months post-stroke. At 3 months, psychiatric symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS), and self-reported changes in cognitive symptoms (concentration and memory) compared to pre-stroke were assessed using single-item measures. At 12 months, single-item questions about changes in self-reported difficulties sleeping at night, fatigue and daytime sleep were included. First, we studied whether self-reported cognitive and/or psychiatric symptoms at 3 months were associated with daytime sleep and fatigue at 12 months using multiple logistic regression. Second, we fitted 2 structural equation models (SEMs) predicting fatigue and 2 models predicting daytime sleep. We compared a model where only age, sex, stroke severity (National Institutes of Health Stroke Scale; NIHSS), and difficulties sleeping at night predicted fatigue and daytime sleep at 12 months to a model where mental distress (i.e., a latent variable built of cognitive and psychiatric symptoms) was included as an additional predictor of fatigue and daytime sleep at 12 months. Results: Of 156 patients (NIHSS within 24 hours after admission (mean ± SD) = 3.6 ± 4.3, age = 73.0 ± 10.8, 41% female) 37.9% reported increased daytime sleep and 50.0% fatigue at 12 months. Increased psychiatric symptoms and worsened cognitive symptoms were associated with fatigue and daytime sleep at 12 months, after controlling for NIHSS, age, sex, and difficulties sleeping at night. SEM models including mental distress as predictor showed adequate model fit across 3 fit measures (highest RMSEA = 0.063, lowest CFI and TLI, both 0.975). Models without mental distress were not supported. Conclusion: Self-reported cognitive and psychiatric symptoms at 3 months predict increased daytime sleep and fatigue at 12 months. This highlights the relevance of monitoring cognitive and psychiatric symptoms in the subacute phase post-stroke. However, future research using validated measures of self-reported symptoms are needed to further explore these relationships.

• Dahl, Fredrik Andreas; Barra, Mathias; Faiz, Kashif Waqar; Ihle-Hansen, Hege; Næss, Halvor & Rand, Kim [Show all 10 contributors for this article] (2022). Stroke unit demand in Norway – present and future estimates. BMC Health Services Research. 22(1). doi: 10.1186/s12913-021-07385-1. Full text in Research Archive Show summary

  Background All stroke patients should receive timely admission to a stroke unit (SU). Consequently, most patients with suspected strokes – including stroke mimics (SM) are admitted. The aim of this study was to estimate the current total demand for SU bed capacity today and give estimates for future (2020–2040) demand. Methods Time trend estimates for stroke incidence and time constant estimates for length of stay (LOS) were estimated from the Norwegian Patient Registry (2010–2015). Incidence and LOS models for SMs were based on data from Haukeland University Hospital (2008–2017) and Akershus University Hospital (2020), respectively. The incidence and LOS models were combined with scenarios from Statistic Norway’s population predictions to estimate SU demands for each health region. A telephone survey collected data on the number of currently available SU beds. Results In 2020, 361 SU beds are available, while demand was estimated to 302. The models predict a reduction in stroke incidence, which offsets projected demographic shifts. Still, the estimated demand for 2040 rose to 316, due to an increase in SMs. A variation of this reference scenario, where stroke incidence was frozen at the 2020-level, gave a 2040-demand of 480 beds. Conclusions While the stroke incidence is likely to continue to fall, this appears to be balanced by an increase in SMs. An important uncertainty is how long the trend of decreasing stroke incidence can be expected to continue. Since the most important uncertainty factors point toward a potential increase, which may be as large as 50%, we would recommend that the health authorities plan for a potential increase in the demand for SU bed capacity.

• Johannessen, Anne-Kari M.; Barra, Georg Mathias Honoré; Vullum, Sylvi & Werner, Anne (2021). Nursing students’ evaluation of clinical learning environment and supervision in a Norwegian hospital placement – A questionnaire survey using CLES+T scale. Nurse Education in Practice. ISSN 1471-5953. 54(1). doi: 10.1016/j.nepr.2021.103119. Full text in Research Archive Show summary

  Abstract Aim The clinical learning environment and supervisor-student relationship play vital roles in the learning outcomes of nursing students. The aim of this study is to evaluate nursing students’ experiences with the clinical learning environment and supervision in a hospital placement organised with a dual preceptor team – preceptors holding dual positions both in the clinic and the nursing faculty in addition to the standard one-to-one supervision by a clinical preceptor. Design The study is a paper-based survey based on a validated questionnaire developed and tested in hospital settings in various European countries, including Norway. Method The Norwegian version of the CLES+T Evaluation Scale, was distributed to all second-year students in three different years (2015–2017) at a nursing faculty. Results A total of 61% students (n=261) returned the questionnaire. Overall, the students considered that their hospital placement provided a good clinical learning environment. The results suggest that the dual preceptor team on top of one-to-one supervision did not interfere negatively with the clinical learning environment Nevertheless, the dual preceptor model did not compensate for a poor relationship with the clinical preceptor. Thus, the association between a reported ‘strained relationship’ with the clinical preceptor and low scores on the CLES+T, reported on by other studies, remained in our data. Conclusions To better grasp the complexity in this area, various methods are needed, such as in-depth interviews with students, nurse teachers and clinical preceptors. Further studies need to elaborate on students’ experiences of clinical learning environment according to how supervision is organised.

• Horn, Sindre August; Barra, Mathias; Norheim, Ole Frithjof & Solberg, Carl Tollef (2021). Public health priority setting: A case for priority to the worse off in well-being during the COVID-19 pandemic. Etikk i praksis. ISSN 1890-3991. 15(2), p. 5–15. doi: 10.5324/eip.v15i2.4097. Full text in Research Archive Show summary

  In Norway, priority for health interventions is assigned on the basis of three official criteria: health benefit, resources, and severity. Responses to the COVID-19 pandemic have mainly been through intersectoral public health efforts such as lockdowns, quarantines, information campaigns, social distancing, and, in the later phase, vaccine distribution. The aim of this article is to evaluate potential priority setting criteria for public health interventions. We argue in favour of the following three criteria for public health priority setting: benefit, resources and improving the well-being of the worse off. We argue that benefits and priority to the worse off may reasonably be understood in terms of individual well-being, rather than only health, for public health priority setting. We argue that lessons from the COVID-19 pandemic support our conclusions.

• Dahl, Silje Langseth; Vaksdal, Rebekka Hylland; Barra, Mathias; Gamlund, Espen & Solberg, Carl Tollef (2021). Abortion and multifetal pregnancy reduction: An ethical comparison (English translation). Etikk i praksis. ISSN 1890-3991. 15(1), p. 51–73. doi: 10.5324/eip.v15i1.3980. Full text in Research Archive Show summary

  In recent years, multifetal pregnancy reduction (MFPR) has increasingly been a subject of debate in Norway. The intensity of this debate reached a tentative maximum when the Legislation Department delivered their interpretative statement, Section 2 -Interpretation of the Abortion Act, in 2016 in response to a request from the Ministry of Health (2014) that the Legislation Department consider whether the Abortion Act allows for MFPR of healthy fetuses in multiple pregnancies. The Legislation Department concluded that the current abortion legislation [as of 2016] allows for MFPR subject to the constraints that the law otherwise stipulates. The debate has not subsided, and during autumn 2018 it was further intensified in connection with the Norwegian Christian Democratic "crossroads" policy and signals from the Conservatives to consider removing section 2.3c and to forbid MFPR.Many of the arguments in the MFPR debate are seemingly similar to arguments put forward in the general abortion debate, and an analysis toascertain what distinguishes MFPR from other abortions has yet to be conducted. The aim of this article is, therefore, to examine whether there is a moral distinction between abortion and MFPR of healthy fetuses. We will cover the typical arguments emerging in the debate in Norway and exemplify them with scholarly articles from the literature. We have dubbed the most important arguments against MFPR that we have identified the harm argument, the slippery-slope argument, the intentionargument, the grief argument, the long-term psychological effects for the woman argument, and the sorting argument. We conclude that these arguments do not measure up in terms of demonstrating a morally relevant difference between MFPR of healthy fetuses and other abortions. Our conclusion is, therefore —despite what several discussants seem to think —that there is no morally relevant difference between the two. Therefore, on the same conditions as we allow for abortions, we should also allow MFPR. Keywords: abortion, ethics,medical ethics, MFPR, selective MFPR

• Barra, Georg Mathias Honoré; Faiz, Kashif Waqar; Dahl, Fredrik Andreas & Næss, Halvor (2021). Stroke Mimics on the Stroke Unit – Temporal trends 2008–2017 at a large Norwegian university hospital. Acta Neurologica Scandinavica. ISSN 0001-6314. 144(6), p. 695–705. doi: 10.1111/ane.13527. Full text in Research Archive Show summary

  Objectives: The objective was to quantify temporal trends in stroke mimics (SM) admissions relative to cerebrovascular accidents (CVA), incidence of hospitalized SMs and characterize the SM case-mix at a general hospital's stroke unit (SU). Materials & Methods: All SU admissions (n = 11240) of patients aged 15 or older to Haukeland University Hospital between 2008–2017 were prospectively included and categorized as CVA or SM. Logistic regression was used to estimate time trends in the proportion of SMs among the admissions. Poisson regression was used to estimate time trends in age- and sex-dependent SM incidence. Results: SMs were on average younger thaan CVA patients (68.3 vs. 71.4 years) and had a higher proportion of females (53.6% vs. 44.5%). The total proportion of SM admissions was 51.0%. There was an increasing time trend in the proportion of SM admissions, odds ratio 1.150 per year (p < 0.001), but this trend appears flattening, represented by a significant quadratic time-term, odds ratio 1.009 (p < 0.001). A higher SM proportion was also associated with the time period of a Mass Media Intervention (FAST campaign) in 2014. There was also an increasing trend in SM incidence, that remains after adjusting for age, sex, and population; also, for incidence the trend appears to be flattening. Conclusions: SMs account for approximately half of the SU admissions, and the proportion has been increasing. A FAST campaign appears to have temporarily increased the SM proportion. The age- and sex-dependent incidence of SM has been increasing but appears to flatten out.

• Lamu, Admassu Nadew; Norheim, Ole Frithjof; Gregersen, Fredrik A. & Barra, Mathias (2021). Cycle-network expansion plan in Oslo: Modeling cost-effectiveness analysis and health equity impact. Health Economics. ISSN 1057-9230. 30(12), p. 3220–3235. doi: 10.1002/hec.4435. Full text in Research Archive Show summary

  Physical inactivity is the leading cause of non-communicable diseases, and further research on the cost-effectiveness of interventions that target inactivity is warranted. Socioeconomic status is vital in this process. We aim to evaluate the cost-effectiveness of a cycle-network expansion plan in Oslo compared to the status quo by income quintiles. We applied a Markov model using a public payer perspective. Health outcomes were measured by quality-adjusted life years (QALYs) gained from the prevention of coronary heart disease, stroke, type 2 diabetes, and cancer. We measured equity impact by the concentration index and social welfare using the achievement index. We conducted sensitivity analyses. The intervention was generally more costly and more effective than the status quo. Incremental cost per QALY falls with income quintile, ranging from $10,098 in the richest quintile to $23,053 per QALY gained in the poorest quintile. The base-case intervention increased health inequality. However, a scenario targeting low-income quintiles reduced inequality and increased social welfare. In conclusion, the cycle-network expansion is likely to be cost-effective, but with equity concerns. If decision makers care about health inequalities, the disadvantaged groups could be targeted to produce more equitable and socially desirable outcomes instead of a uniform intervention across income quintiles.

• Horn, Sindre August; Jølstad, Odd Borgar; Barra, Georg Mathias Honoré & Solberg, Carl Tollef (2021). Er covid-19 alvorlig? Det norske alvorlighetskriteriet for helseprioriteringer i møte med en pandemi. Tidsskrift for velferdsforskning. ISSN 0809-2052. 24(2), p. 1–14. doi: 10.18261/issn.2464-3076-2021-02-01. Full text in Research Archive Show summary

  Koronapandemien har synliggjort nødvendigheten av prioriteringer i helsetjenesten vår. Helseprioriteringer i Norge skal gjøres etter de tre kriteriene nytte, ressurs og alvorlighetsgrad. Nytte- og ressurskriteriene utgjør til sammen et kostnadseffektivitetskriterium: Høyere prioritet tilfaller tiltak som skaper mye helse med få ressurser. Alvorlighets- kriteriet innebærer at en mer alvorlig tilstand kan og skal prioriteres høyere enn kostnadseffektiviteten alene tilsier. I denne artikkelen undersøker vi det norske alvorlighetskriteriet for helseprioriteringer i møte med koronaepidemien i Norge. Vi beskriver utviklingen av alvorlighetskriteriet i den norske prioriteringsdiskursen. Videre diskuterer vi hvordan koronaepidemien fremhever uenigheter og tvetydigheter rundt begrepet «alvorlighet» hva gjelder dødsrisiko, komorbiditet og hastegrad. Vi drøfter også hvordan den norske pandemiberedskapen passer inn i dette landskapet og etterlyser en klarere forståelse av alvorlighet i skillet mellom behandling og forebygging av sykdom. Til sist drøfter vi om det norske alvorlighetskriteriet for helseprioriteringer også kan være relevant for prioriteringer utenfor helse- vesenet.

• Solberg, Carl Tollef; Barra, Mathias & Robberstad, Bjarne (2020). Bør vi diskontere fremtidige helsegevinster? Pro et contra. Norsk filosofisk tidsskrift. ISSN 0029-1943. 55(2–3), p. 170–184. doi: 10.18261/issn.1504-2901-2020-02-03-07. Full text in Research Archive Show summary

  Målet med denne artikkelen er å undersøke de viktigste argumentene for og imot diskontering av fremtidige helsegevinster. Et mer generelt spørsmål dreier seg om hvorvidt vi bør diskontere fremtidig velferd (eng. well-being). Vi begynner med en redegjørelse av hva diskontering er, og hvordan diskontering påvirker evaluering av helsetiltak. Deretter tar vi for oss de mest sentrale argumentene for og imot diskontering av fremtidige helsegevinster. Dette inkluderer velkjente argumenter som grensenytteargumentet, risikoargumentet, utsettelsesargumentet, konsistensargumentet og rene positive tidspreferanser. I tillegg drøfter vi to lite diskuterte argumenter, nemlig det instrumentelle argumentet og argumentet for fordelingsrettferdighet, samt en alternativ form for diskontering, nemlig diskontinuerlig diskontering. Vi konkluderer åpent og lar det være opp til deg som leser å reflektere videre omkring dette viktige spørsmålet.

• Labberton, Angela Susan; Augestad, Liv Ariane; Thommessen, Bente & Barra, Georg Mathias Honore (2020). The association of stroke severity with health-related quality of life in survivors of acute cerebrovascular disease and their informal caregivers during the first year post stroke: a survey study. Quality of Life Research. ISSN 0962-9343. doi: 10.1007/s11136-020-02516-3. Full text in Research Archive
• Barra, Mathias; Broqvist, Mari; Gustavsson, Erik; Henriksson, Martin; Juth, Niklas & Sandman, Lars [Show all 7 contributors for this article] (2020). Do not despair about severity—yet. Journal of Medical Ethics. ISSN 0306-6800. 0(0), p. 1–2. doi: 10.1136/medethics-2019-105870. Full text in Research Archive Show summary

  In a recent extended essay, philosopher Daniel Hausman goes a long way towards dismissing severity as a morally relevant attribute in the context of priority setting in healthcare. In this response, we argue that although Hausman certainly points to real problems with how severity is often interpreted and operationalised within the priority setting context, the conclusion that severity does not contain plausible ethical content is too hasty. Rather than abandonment, our proposal is to take severity seriously by carefully mapping the possibly multiple underlying accounts to well-established ethical theories, in a way that is both morally defensible and aligned with the term’s colloquial uses.

• Solberg, Carl Tollef; Sørheim, Preben; Muller, Karl Erik; Gamlund, Espen; Norheim, Ole Frithjof & Barra, Mathias (2020). The devils in the DALY: Prevailing evaluative assumptions. Public Health Ethics. ISSN 1754-9973. 13(3), p. 259–274. doi: 10.1093/phe/phaa030. Full text in Research Archive Show summary

  In recent years, it has become commonplace among the Global Burden of Disease (GBD) study authors to regard the disability-adjusted life year (DALY) primarily as a descriptive health metric. During the first phase of the GBD (1990–1996), it was widely acknowledged that the DALY had built-in evaluative assumptions. However, from the publication of the 2010 GBD and onwards, two central evaluative practices—time discounting and age-weighting—have been omitted from the DALY model. After this substantial revision, the emerging view now appears to be that the DALY is primarily a descriptive measure. Our aim in this article is to argue that the DALY, despite changes, remains largely evaluative. Our analysis focuses on the understanding of the DALY by comparing the DALY as a measure of disease burden in the two most significant phases of GBD publications, from their beginning (1990–1996) to the most recent releases (2010–2017). We identify numerous assumptions underlying the DALY and group them as descriptive or evaluative. We conclude that while the DALY model arguably has become more descriptive, it remains, by necessity, largely evaluative.

• Barra, Georg Mathias Honoré; Dahl, Fredrik Andreas; Vetvik, Kjersti & MacGregor, E. Anne (2020). A Markov chain method for counting and modelling migraine attacks. Scientific Reports. 10:3631, p. 1–10. doi: 10.1038/s41598-020-60505-5. Full text in Research Archive Show summary

  Abstract To ensure reproducibility in research quantifying episodic migraine attacks, and identifying attack onset, a sound theoretical model of a migraine attack, paired with a uniform standard for counting them, is necessary. Many studies report on migraine frequencies—e.g. the fraction of migraine-days of the observed days—without paying attention to the number of discrete attacks. Furthermore, patients’ diaries frequently contain single, migraine-free days between migraine-days, and we argue here that such ‘migraine-locked days’ should routinely be interpreted as part of a single attack. We tested a simple Markov model of migraine attacks on headache diary data and estimated transition probabilities by mapping each day of each diary to a unique Markov state. We explored the validity of imputing migraine days on migraine-locked entries, and estimated the effect of imputation on observed migraine frequencies. Diaries from our patients demonstrated significant clustering of migraine days. The proposed Markov chain model was shown to approximate the progression of observed migraine attacks satisfactorily, and imputing on migraine-locked days was consistent with the conceptual model for the progression of migraine attacks. Hence, we provide an easy method for quantifying the number and duration of migraine attacks, enabling researchers to procure data of high inter-study validity.

• Augestad, Liv Ariane; Rand, Kim; Luo, Nan & Barra, Mathias (2019). Using the choice sequence in time trade-off as discrete choices: do the two stories match? Value in Health. ISSN 1098-3015. p. 1–8. doi: 10.1016/j.jval.2019.10.003. Full text in Research Archive
• Labberton, Angela Susan; Rønning, Ole M.; Thommessen, Bente & Barra, Mathias (2019). Changes in survival and characteristics among older stroke unit patients-1994 versus 2012. Brain and Behavior. 9(1). doi: 10.1002/brb3.1175. Full text in Research Archive Show summary

  Objectives Treatment on organized stroke units (SUs) improves survival after stroke, and stroke mortality has decreased worldwide in recent decades; however, little is known of survival trends among SU patients specifically. This study investigates changes in survival and characteristics of older stroke patients receiving SU treatment. Materials & Methods We compared 3‐year all‐cause mortality and baseline characteristics in two cohorts of stroke patients aged ≥60 consecutively admitted to the same comprehensive SU in 1994 (n = 271) and 2012 (n = 546). Results Three‐year survival was 53.9% in 1994 and 56.0% in 2012, and adjusted hazard ratio (HR) was 0.99 (95% CI: 0.77–1.28). Adjusted 30‐day case fatality was slightly higher in 2012, 18.9% versus 16.2%, HR 1.68 (95% CI: 1.14–2.47). There were no significant between‐cohort differences in survival beyond 30 days. Patients in 2012 were older (mean age: 78.8 vs. 76.7 years) and more often admitted from nursing homes. There were higher rates of atrial fibrillation (33.7% vs. 21.4%) and malignancy (19.2% vs. 8.9%), and prescription of antiplatelets (46.9% vs. 26.2%) and warfarin (16.3% vs. 5.5%) at admission. Stroke severity was significantly milder in 2012, proportion with mild stroke 66.1% versus 44.3%. Conclusions Three‐year survival in older Norwegian stroke patients treated on an SU remained stable despite improved treatment in the last decades. Differences in background characteristics may explain this lack of difference; patients in 2012 were older, more often living in supported care, and had higher prestroke comorbidity; however, their strokes were milder and risk factors more often treated.

• Solberg, Carl Tollef; Norheim, Ole Frithjof & Barra, Mathias (2019). Consistency is not overrated. Journal of Medical Ethics. ISSN 0306-6800. 45(12), p. 830–831. doi: 10.1136/medethics-2019-105662. Full text in Research Archive Show summary

  In a recent paper—The disvalue of death in the global burden of disease—we question the commensurability of the two components of the disability-adjusted life year (DALY)—years lived with disability (YLDs) and years of life lost (YLLs)—and offer a tentative solution to this problem. In an exciting and constructive reply—Is consistency overrated?—philosopher S Andrew Schroeder argues that our concern about the DALY may be missing the mark by accepting the DALY as what he refers to as an index reflecting nothing ‘beyond the importance we place in each (DALY component). According to Schroeder, our consistency requirement is then made redundant.

• Barra, Mathias; Labberton, Angela Susan; Faiz, Kashif Waqar; Lindstrøm, Jonas Christoffer; Rønning, Ole M. & Viana, Joe [Show all 8 contributors for this article] (2019). Stroke incidence in the young: evidence from a Norwegian register study. Journal of Neurology. ISSN 0340-5354. p. 1–17. doi: 10.1007/s00415-018-9102-6. Full text in Research Archive
• Barra, Mathias; Broqvist, Mari; Gustavsson, Erik; Henriksson, Martin; Juth, Niklas & Sandman, Lars [Show all 7 contributors for this article] (2019). Severity as a priority setting criterion: Setting a challenging research agenda. Health Care Analysis. ISSN 1065-3058. p. 1–20. doi: 10.1007/s10728-019-00371-z. Full text in Research Archive Show summary

  Priority setting in health care is ubiquitous and health authorities are increasingly recognising the need for priority setting guidelines to ensure efficient, fair, and equitable resource allocation. While cost-effectiveness concerns seem to dominate many policies, the tension between utilitarian and deontological concerns is salient to many, and various severity criteria appear to fill this gap. Severity, then, must be subjected to rigorous ethical and philosophical analysis. Here we first give a brief history of the path to today’s severity criteria in Norway and Sweden. The Scandinavian perspective on severity might be conducive to the international discussion, given its long-standing use as a priority setting criterion, despite having reached rather different conclusions so far. We then argue that severity can be viewed as a multidimensional concept, drawing on accounts of need, urgency, fairness, duty to save lives, and human dignity. Such concerns will often be relative to local mores, and the weighting placed on the various dimensions cannot be expected to be fixed. Thirdly, we present what we think are the most pertinent questions to answer about severity in order to facilitate decision making in the coming years of increased scarcity, and to further the understanding of underlying assumptions and values that go into these decisions. We conclude that severity is poorly understood, and that the topic needs substantial further inquiry; thus we hope this article may set a challenging and important research agenda.

• Rand, Kim; Dahl, Fredrik Andreas; Viana, Joe; Rønning, Ole M.; Faiz, Kashif Waqar & Barra, Mathias (2019). Fewer ischemic strokes, despite an ageing population: stroke models from observed incidence in Norway 2010–2015. BMC Health Services Research. 19(1). doi: 10.1186/s12913-019-4538-7. Full text in Research Archive Show summary

  Background Stroke incidence rates have fallen in high-income countries over the last several decades, but findings regarding the trend over recent years have been mixed. The aim of the study was to describe and model temporal trends in incidence of stroke by age and sex between 2010 and 2015 in Norway, and to generate incidence projections towards year 2040. Methods All recorded strokes in Norway between 2010 and 2015 were extracted from the National Patient Registry and the National Cause of Death Registry. We report incidence by age, sex, and year; in raw numbers, per 100,000 person-years, by WHO and European standard populations; and generated statistical models by stroke type, age, sex, and year; and projected stroke incidence toward year 2040. Results The data covered 30.1 million person-years at risk, 53431 unique individuals hospitalized with a primary stroke diagnosis, and 6315 additional individuals registered as dead due to stroke. From 2010 to 2015, individuals suffering stroke per 100,000 person-years dropped from 239 to 195 (208 to 177 excluding immediate deaths). The decline was driven by ischemic strokes, with a statistically non-significant time trend for hemorrhagic stroke. Conclusions The age-dependent incidence of ischemic strokes in Norway is declining rapidly, and more than compensates for the growth and ageing of the population. Comparisons with historic incidence statistics show that the reduction in incidence rates has accelerated over the last two decades.

• Dahl, Silje Langseth; Vaksdal, Rebekka Hylland; Barra, Mathias; Gamlund, Espen & Solberg, Carl Tollef (2019). Abort og fosterreduksjon: En etisk sammenligning. Etikk i praksis. ISSN 1890-3991. 13(1), p. 89–111. doi: 10.5324/eip.v13i1.3002. Full text in Research Archive Show summary

  De siste årene har fosterreduksjon i økende grad vært gjenstand for debatt i Norge, og intensiteten nådde et foreløpig maksimum da Lovavdelingen leverte tolknings-uttalelsen § 2 - Tolkning av abortloven i 2016 som svar på at Helse- og omsorgs-departementet (i 2014) ba Lovavdelingen om å vurdere hvorvidt Lov om svangers-kapsavbrudd åpner for fosterreduksjon av friske fostre ved flerlings-vangerskap. Lovavdelingen konkluderte med at abortloven åpner for fosterreduksjon ved flerlingsvangerskap innenfor de rammene som loven ellers oppstiller. Debatten har ikke stilnet, og utover høsten 2018 ble den ytterligere tilspisset i forbindelse med KrFs veivalg og signaler fra Høyre om å vurdere å fjerne § 2.3c, samt å forby fosterreduksjon. Mange av argumentene i fosterreduksjonsdebatten fremstår tilsynelatende like de argumentene som verserer i abortdebatten, og det mangler en analyse av hva som stiller seg annerledes ved fosterreduksjon. Målet med denne artikkelen er følgelig å undersøke hvorvidt det finnes en moralsk relevant forskjell mellom abort og fosterreduksjon av friske fostre. Vi tar for oss typiske argumenter fra den norske debatten, og belyser dem med fagartikler fra forskningslitteraturen. De mest sentrale argumentene mot fosterreduksjon har vi identifisert som skadeargumentet, skråplansargumentet, intensjonsargumentet, sorgargumentet, psykologiske langtids-effekter for kvinnen og sorteringsargumentet. Vi kommer frem til at motargumentene ikke holder mål hva gjelder å påvise en moralsk relevant forskjell mellom abort og fosterreduksjon av friske fostre. Konklusjonen vår er derfor at det – på tross av hva flere debattanter synes å mene - ikke finnes en moralsk relevant forskjell mellom de to. Når vi derfor tillater abort, så bør vi også tillate fosterreduksjon.

• Barra, Mathias; Dahl, Fredrik Andreas; MacGregor, E. Anne & Vetvik, Kjersti (2019). Identifying menstrual migraine- improving the diagnostic criteria using a statistical method. The Journal of Headache and Pain. ISSN 1129-2369. 20(1). doi: 10.1186/s10194-019-1035-7. Full text in Research Archive Show summary

  Objective To develop a robust statistical tool for the diagnosis of menstrually related migraine. Background The International Classification of Headache Disorders (ICHD) has diagnostic criteria for menstrual migraine within the appendix. These include the requirement for menstrual attacks to occur within a 5-day window in at least 2/3 menstrual cycles (2/3-criterion). While this criterion has been shown to be sensitive, it is not specific. Yet in some circumstances, for example to establish the underlying pathophysiology of menstrual attacks, specificity is also important, to ensure that only women in whom the relationship between migraine and menstruation is more than a chance occurrence are recruited. Methods Using a simple mathematical model, a Markov chain, to model migraine attacks we developed a statistical criterion to diagnose menstrual migraine (sMM). We then analysed a data set of migraine diaries using both the 2/3-criterion and the sMM. Results sMM was superior to the 2/3-criterion for varying numbers of menstrual cycles and increased in accuracy with more cycle data. In contrast, the 2/3-criterion showed maximum sensitivity only for three cycles, although specificity increased with more cycle data. Conclusions While the ICHD 2/3-criterion is a simple screening tool for menstrual migraine, the sMM provides a more specific diagnosis and can be applied irrespective of the number of menstrual cycles recorded. It is particularly useful for clinical trials of menstrual migraine where a chance association between migraine and menstruation must be excluded.

• Faiz, Kashif Waqar; Labberton, Angela Susan; Thommessen, Bente; Rønning, Ole M. & Barra, Mathias (2019). Stroke-Related Knowledge and Lifestyle Behavior among Stroke Survivors. Journal of Stroke & Cerebrovascular Diseases. ISSN 1052-3057. p. 1–7. doi: 10.1016/j.jstrokecerebrovasdis.2019.104359. Full text in Research Archive

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• Barra, Mathias (2026). Prioritering i helsetjenesten. Full text in Research Archive
• Barra, Mathias (2025). Health Technology Assessment & Priority Setting 101. Full text in Research Archive
• Barra, Mathias (2025). «Alternativkostnaden» må reflektere alternativkostnaden. doi: https:/www.altinget.no/artikkel/alternativkostnaden-maa-reflektere-alternativkostnaden. Full text in Research Archive
• Barra, Mathias (2025). Calibration Theorems for Prioritarianism. Full text in Research Archive Show summary

  Recent contributions on so-called calibration theorems for priority setting in health care both over- and understate their significance. We present work that show that all Rabin-style utility functions are bounded, and discuss whether such utility function should be admissible as "prioritarian" in the first place.

• Barra, Mathias (2025). VIVE Gå hjem-møde: Prioritering i sundhedsvæsenet – Hvad kan vi lære fra Norge og Sverige? doi: https:/www.vive.dk/da/arrangementer/2025/gaa-hjem-moede-prioritering-i-sundhedsvaesenet-hvad-kan-vi-laere-fra-norge-og-sverige/. Full text in Research Archive
• Barra, Mathias (2025). Priority Setting in Norway. doi: https:/liu.diva-portal.org/smash/get/diva2:2016999/FULLTEXT01.pdf. Full text in Research Archive
• Barra, Georg Mathias Honoré (2024). Severity and Inequality - A Priority Setting Saga. Full text in Research Archive
• Barra, Georg Mathias Honoré & Jølstad, Odd Borgar (2024). The other sorts - exploring the underwood. Full text in Research Archive
• Torjusen, Marius Lamberg; Rand, Kim; Whitehurst, David GT; Stavem, Knut & Barra, Georg Mathias Honoré (2024). Preferences for extending Lives. Full text in Research Archive
• Torjusen, Marius Lamberg; Rand, Kim; Whitehurst, David GT; Stavem, Knut & Barra, Georg Mathias Honoré (2024). SEVQoL del 2 - Hvem skal få leve litt lengre? Full text in Research Archive
• Barra, Georg Mathias Honoré (2024). Prioritering betyr å la være å gjøre noe – prioriteringsveilederen for psykisk helsevern nå og fremover – implikasjoner for hvilke pasienter som skal hvor i tjenesten. Full text in Research Archive
• Torjusen, Marius Lamberg; Rand, Kim; Whitehurst, David GT; Stavem, Knut & Barra, Georg Mathias Honoré (2024). A preference for the better-off? A discrete choice experiment using individually calibrated EQ-5D-5L health state values. Full text in Research Archive
• Torjusen, Marius Lamberg; Rand, Kim; Whitehurst, David GT; Stavem, Knut & Barra, Georg Mathias Honoré (2024). Hvem skal få leve litt lengre? - Foreløpige resultater fra en norsk preferansestudie. Full text in Research Archive
• Torjusen, Marius Lamberg; Rand, Kim; Whitehurst, David GT; Stavem, Knut & Barra, Georg Mathias Honoré (2024). A preference for the better-off? A discrete choice experiment using individually calibrated EQ-5D-5L health state values. Full text in Research Archive
• Barra, Georg Mathias Honoré & Adil, Muhammed Yasin (2024). Prioriteringskriterier og CLINPRI. Full text in Research Archive
• Barra, Georg Mathias Honoré (2024). Alvorlighetskriteriet for helseprioriteringer. Full text in Research Archive
• Barra, Georg Mathias Honoré (2024). Dead serious? Severity, dying, death and Priority Setting. Full text in Research Archive Show summary

  In Norway, deaths matter for priority setting in health care through at least two mechanisms. First, they contribute to estimates of QALY (quality-adjusted life years) gains and losses, which are central to ICER-based (incremental cost-effectiveness ratio) decision-making. Secondly, the risk of death or proximity to death can act as a decision modifier or weight in cost-effectiveness assessments. For instance, conditions associated with an increased risk of death are often considered more "severe." This talk provides an overview of how severity is conceptualised in priority setting, with a focus on the technical definition used in Norway. I also explore whether public perceptions of illness severity align with its technical operationalisation. Drawing on recent studies by Stenmarck et al., I argue that while the relationship between death and severity may be less direct than suggested in official guidelines, there remains a plausible role for considering death as a distinct factor in priority setting alongside the severity criterion.

• Barra, Georg Mathias Honoré (2024). Alvorlighet og helseprioriteringer. Full text in Research Archive
• Barra, Georg Mathias Honoré (2024). Priority setting: the meanings of severity. Full text in Research Archive
• Barra, Georg Mathias Honoré & Jølstad, Odd Borgar (2024). Presentasjon av SEVPRI - Alvorlighet og helseprioriteringer. Full text in Research Archive
• Barra, Georg Mathias Honoré (2024). Helsetjenesteforskning og prioriteringer. Full text in Research Archive
• Barra, Georg Mathias Honoré (2024). Prioriteringskriterier, forskningsresultater og en ny HSØ‐finansiert studie. Full text in Research Archive
• Barra, Mathias (2024). Alvorligheter. Full text in Research Archive
• Barra, Georg Mathias Honoré; Whitehurst, David G T; Sandman, Lars; Jølstad, Odd Borgar & Ehlert, Adam (2024). Severity – Ethics, Evidence, and Application. Full text in Research Archive
• Gamlund, Espen & Barra, Mathias (2024). Surrogati er ikke menneskehandel. Klassekampen. ISSN 0805-3839. Full text in Research Archive
• Gamlund, Espen & Barra, Mathias (2024). Uenigheter om surrogati. Klassekampen. ISSN 0805-3839. Full text in Research Archive
• Gamlund, Espen; Barra, Mathias & Brautaset, Trygve (2024). Surrogati bør ikke straffes. Morgenbladet. ISSN 0805-3847. Full text in Research Archive
• Gamlund, Espen & Barra, Mathias (2024). Surrogati bør bli tillatt i Norge. Full text in Research Archive
• Barra, Mathias (2024). Hva menes med "sykdommens alvorlighetsgrad?". Full text in Research Archive
• Horn, Sindre August; Norheim, Ole Frithjof & Barra, Georg Mathias Honoré (2024). Eliciting Aversion to Inequality in Health in a Representative Sample of the Norwegian Population. Full text in Research Archive
• Stenmarck, Mille Sofie; Barra, Georg Mathias Honoré; Baker, Rachel; Whitehurst, David G T & Jølstad, Odd Borgar (2023). A severely fragmented concept: a Q-methodological investigation of subjective accounts of severity in priority setting. Full text in Research Archive
• Barra, Mathias (2023). Severity as a moral qualifier of malady. Full text in Research Archive
• Barra, Georg Mathias Honoré; Stenmarck, Mille Sofie; Whitehurst, David G T & Baker, Rachel (2023). Q2S methodology - Testing triplets for Q2S. Full text in Research Archive
• Torjusen, Marius Lamberg; Rand, Kim; Whitehurst, David GT.; Stavem, Knut & Barra, Mathias (2023). Alvorlighet eller helsegevinst - Hva prioriterer befolkningen? Full text in Research Archive
• Barra, Mathias (2023). Prioriteringer i helsevesenet. Full text in Research Archive
• Barra, Mathias; Stenmarck, Mille Sofie; Jølstad, Odd Borgar & Horn, Sindre August (2023). Rådgiverpanelmøte for SEVPRI;. Full text in Research Archive
• Barra, Mathias (2023). Paneldebatt: Nye metoder. Full text in Research Archive
• Torjusen, Marius Lamberg; Rand, Kim; Stavem, Knut; Whitehurst, David G T & Barra, Mathias (2023). Alvorlighet og EQ-5D - Hvordan bruke livskvalitetsverktøy til å få nye innsikter om befolkningens intuisjoner rundt prioriteringer i helsevesenet. Full text in Research Archive
• Torjusen, Marius Lamberg; Rand, Kim; Whitehurst, David GT.; Stavem, Knut & Barra, Mathias (2023). SEVQoL, Severity and EQ-5D-5L, An early look. Full text in Research Archive
• Horn, Sindre August; Norheim, Ole Frithjof & Barra, Georg Mathias Honoré (2023). Aversjon mot ulikhet i helse i et representativt utvalg av befolkningen i Norge. Full text in Research Archive
• Barra, Georg Mathias Honoré & Stenmarck, Mille Sofie (2022). Idealised Q-Sorts - A novel approach? Full text in Research Archive
• Stenmarck, Mille Sofie; Jølstad, Odd Borgar; Baker, Rachel; Barra, Georg Mathias Honoré & Whitehurst, David G T (2022). Severity as a in priority-setting criterion. Full text in Research Archive
• Stenmarck, Mille Sofie; Jølstad, Odd Borgar; Baker, Rachel; Barra, Georg Mathias Honoré & Whitehurst, David G T (2022). A severely fragmented concept? A Q-methodological investigation of subjective accounts of severity in priority-setting. Full text in Research Archive
• Barra, Georg Mathias Honoré (2022). Severity as a moral qualifier of malady. Full text in Research Archive
• Barra, Georg Mathias Honoré (2022). Ask not what the world is good for, but instead what good you can do for the world. Full text in Research Archive
• Kliem, Elisabeth; Labberton, Angela Susan; Barra, Mathias; Gjestad, Elise Ødegård; Olsen, Alexander & Thommessen, Bente [Show all 8 contributors for this article] (2022). Self-reported mental distress at 3 months predicts daytime sleep and fatigue 12 months after ischemic stroke: A structural equation modeling analysis. Full text in Research Archive
• Stenmarck, Mille Sofie; Jølstad, Odd Borgar; Baker, Rachel; Whitehurst, David & Barra, Georg Mathias Honoré (2022). A severely fragmented concept? A Q-methodological investigation of subjective accounts of severity in priority-setting. Full text in Research Archive
• Torjusen, Marius Lamberg; Solberg, Carl Tollef; Barra, Mathias & Feiring, Eli (2022). Priority setting in Norwegian municipal health and care services: A content analysis of policy documents. BMJ Global Health. 7. doi: 10.1136/bmjgh-2022-ISPH.73. Full text in Research Archive Show summary

  Introduction Norway has a long tradition of open priority setting in health care services. However, the principles and instruments for priority setting have mainly been used in specialist health care. In 2017, an official committee was commissioned to evaluate if and how to adopt the three Norwegian priority-setting criteria – health benefit, resources, and severity – in the municipal health and care services. The aim of this article was to examine the arguments for and against implementing the current criteria in municipal health and care services, using documentary data from the ensuing political process. Methods Data consisted of Norwegian policy documents discussing prioritisation principles for municipal health and care services: The Official Norwegian Report 2018:6 (green paper), the written consultation responses from the hearings, and the Report to the Parliament 38 (2020-2021) (white paper). The documents were analysed using a predefined conceptual framework where arguments were categorised by their level of abstraction and the degree of (dis)agreement with the recommendations in the green paper. Results Data suggested general agreement to use the same criteria in all levels of Norwegian health service. However, disagreement was identified when considering the lack of feasible implementation processes. Recurrent themes in the data were the municipalities’ legal and financial lack of scope to set priorities under constraints, challenges regarding operationalising a supplementary physical, psychological and social mastery criterion, and prioritising in situations where the benefits are difficult to measure. Discussion The many duties and responsibilities of municipal health and care make priority setting decisions more complex than in specialist health care. In summary, the Norwegian green paper on priority setting in municipal health and care services has presented a well-received recommendation. However, how to inevitably tackle the many complex, and sometimes wicked, prioritisation problems in practice remain unanswered.

• Barra, Mathias; Stenmarck, Mille Sofie; Jølstad, Odd Borgar; Horn, Sindre August & Simonsen, Tone Breines (2022). Rådgiverpanelmøte. Full text in Research Archive
• Stenmarck, Mille Sofie & Barra, Georg Mathias Honoré (2021). Subjective accounts of severity. Full text in Research Archive
• Barra, Georg Mathias Honoré (2021). ISPOR 2021 - Drop Dead: Is It Time to Remove 'Dead' from Health State Valuation? Full text in Research Archive
• Barra, Mathias & Solberg, Carl Tollef (2020). Presentation of SEVPRI. Full text in Research Archive
• Solberg, Carl Tollef; Sørheim, Preben; Norheim, Ole Frithjof & Barra, Georg Mathias Honore (2020). Helseprioriteringer under en pandemi. Agenda Magasin. Full text in Research Archive
• Barra, Mathias & Solberg, Carl Tollef (2020). SEVPRI. Full text in Research Archive
• Labberton, Angela Susan; Augestad, Liv Ariane; Thommessen, Bente & Barra, Mathias (2020). The impact of stroke severity on health related quality of life in patients with acute cerebrovascular disease and their informal caregivers. Full text in Research Archive
• Solberg, Carl Tollef; Sørheim, Preben; Norheim, Ole Frithjof & Barra, Georg Mathias Honore (2020). Helseprioriteringer under en pandemi. Full text in Research Archive
• Barra, Mathias; Gamlund, Espen; Dahl, Silje Langseth; Rebekka, Hylland Vaksdal & Solberg, Carl Tollef (2019). Fosterantallsreduksjon kan forsvares etisk når abort kan det. Sykepleien. ISSN 0039-7628. p. 1–4. Full text in Research Archive
• Dahl, Silje Langseth; Vaksdal, Rebekka; Barra, Mathias; Gamlund, Espen & Solberg, Carl Tollef (2019). Selvbestemt abort må også gjelde fosterreduksjon. Full text in Research Archive
• Vogt, Yngve; Häikiö, Kristin; Rand, Kim; Labberton, Angela Susan; Cheng, Socheat & Nyttingnes, Olav [Show all 15 contributors for this article] (2019). Helse-Norge kan spare mye penger - se de 15 ideene. Apollon : Forskningsmagasin for Universitetet i Oslo. ISSN 0803-6926. Full text in Research Archive
• Barra, Mathias & Solberg, Carl Tollef (2019). Kriterier for helseprioriteringer. Full text in Research Archive
• Solberg, Carl Tollef & Barra, Mathias (2019). The Devils in the DALY: Evaluating disease burden in the Global Burden of Disease study. Full text in Research Archive
• Labberton, Angela Susan; Rønning, Ole Morten; Thommessen, Bente & Barra, Mathias (2019). Factors predicting access to post-acute inpatient rehabilitation following stroke. Full text in Research Archive
• Labberton, Angela Susan; Rønning, Ole Morten; Thommessen, Bente & Barra, Mathias (2019). Endring i overlevelse og karakteristika blant eldre slagpasienter på Ahus mellom 1994 og 2012. Full text in Research Archive
• Barra, Mathias; Labberton, Angela Susan; Faiz, Kashif Waqar; Lindstrøm, Jonas Christoffer; Rønning, Ole M. & Viana, Joe [Show all 9 contributors for this article] (2019). Slaginsidens i alle aldre – tidstrender og fremskrivninger. Full text in Research Archive
• Barra, Mathias; Faiz, Kashif Waqar & Næss, Halvor (2019). Hjerneslagimitatorer ved Haukeland universitetssykehus 2008-2017. Full text in Research Archive
• Melberg, Hans Olav; Aas, Eline; Hjort, Ingrid; Vorland, lars; Barra, Mathias & Husbyn, Hallstein [Show all 10 contributors for this article] (2024). Perspektiv og prioriteringer: Rapport fra ekspertgruppen perspektiv i prioritering nedsatt av Helse- og omsorgdepartementet. Helse- og omsorgdepartementet. Full text in Research Archive
• Barra, Mathias; Juth, Niklas; Solberg, Carl Tollef & Jølstad, Odd Borgar (2024). A Publicly Informed Objective Theory of Illness Severity. Universitetet i Oslo. ISSN 9788234803741. Full text in Research Archive Show summary

  When allocating scarce medical resources, we strive to do the best we can with the available resources. However, while we aspire to provide as “much health” as possible, we also care about who the beneficiaries are. Severity criteria are operative in Norway, Sweden, The Netherlands, and the UK. These criteria, while differing in interesting ways, all dictate that we should be willing to accept a higher cost of helping those who are severely ill. But what does it mean to be severely ill? Severity is a thick and heterogeneous concept. It is, at least partly, a measure of health-related worse off-ness. Severity also seems to have a prescriptive aspect: we believe that we should do something when an illness is severe. The dissertation builds on and extends arguments from the four included papers, making the case for a fully aggregative objective theory of illness severity informed by popular views. In such a theory, some features of illness are subject-independent, while others are subject dependent.

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