The effectiveness, equity and explainability of health service resource allocation—with applications in kidney transplantation & family planning

Introduction: Halfway to the deadline of the 2030 agenda, humankind continues to face long-standing yet urgent policy and management challenges to address resource shortages and deliver on Sustainable Development Goal 3; health and well-being for all at all ages. More than half of the global population lacks access to essential health services. Additional resources are required and need to be allocated effectively and equitably. Resource allocation models, however, have struggled to accurately predict effects and to present optimal allocations, thus hampering effectiveness and equity improvement. The current advances in machine learning present opportunities to better predict allocation effects and to prescribe solutions that better balance effectiveness and equity. The most advanced of these models tend to be “black box” models that lack explainability. This lack of explainability is problematic as it can clash with professional values and hide biases that negatively impact effectiveness and equity. Methods: Through a novel theoretical framework and two diverse case studies, this manuscript explores the trade-offs between effectiveness, equity, and explainability. The case studies consider family planning in a low income country and kidney allocation in a high income country. Results: Both case studies find that the least explainable models hardly offer improvements in effectiveness and equity over explainable alternatives. Discussion: As this may more widely apply to health resource allocation decisions, explainable analytics, which are more likely to be trusted and used, might better enable progress towards SDG3 for now. Future research on explainability, also in relation to equity and fairness of allocation policies, can help deliver on the promise of advanced predictive and prescriptive analytics.