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# Allocating scarce resources and triage

- Topic

When there is not enough for everyone, resources are shared by fair, public criteria: need, expected benefit and equality, never favouritism.

Updated Nov 5, 2026

## Key points

- Principles: equality, best outcome, priority to the worst off, reciprocity.
- Explicit, public and reviewable criteria (procedural justice).
- Triage in Colombia: five categories; I immediate, II within 30 minutes.
- Triage is not a tool to refuse emergency care.
- Law 1751, art. 15: six criteria for exclusion from public funding.

## What it is

Allocating scarce resources is the ethical problem of deciding who receives a limited resource: an intensive care bed, an organ, a vaccine or the emergency team's time. Distributive justice offers several principles: equality (each person counts the same), best outcomes (saving the most lives or life-years), priority to the worst off, and priority to those who help others. In Colombia, Law 1751 of 2015 sets criteria for excluding services from public funding and Resolution 5596 of 2015 regulates emergency triage.

## Key facts

- Levels: macro-allocation (how much budget goes to health and to which programmes), meso-allocation (each institution) and micro-allocation (which patient receives the resource).
- WHO principles for scarcity: equality (lottery or first come, first served), best outcome, priority to those most in need, and priority to those who help others; they can be combined and change with the degree of scarcity.
- Unacceptable criteria: social worth, ability to pay, connections or traits unrelated to prognosis.
- Triage: a brief clinical assessment that sets the priority of care by need and resources; in Colombia it has five categories (Resolution 5596 of 2015, arts. 3 and 5).
- Triage I needs immediate care; triage II, within thirty minutes at most; in mass-casualty disasters these times do not apply (Resolution 5596, art. 5).
- Law 1751, art. 15: public funds do not pay for services that are cosmetic, without evidence, unauthorised, experimental or abroad; exclusion is decided through a public, technical and participatory procedure.

## In clinical practice

- The allocation decision should be explicit, use criteria known in advance, be open to review and, where possible, be made by someone other than the treating doctor.
- Triage may never be used to refuse emergency care (Resolution 5596, art. 4, paragraph).
- Financial sustainability does not justify refusing the services owed to a patient (Ruling C-313 of 2014 on art. 5, letter i, of Law 1751).

## Legal framework in Colombia

- Statutory Law 1751 of 2015, arts. 5 (sustainable financing), 6 (equity, sustainability, efficiency) and 15 (exclusion criteria).
- Resolution 5596 of 2015 of the Ministry of Health: technical criteria for triage, five categories and duties of providers and payers; checking insurance rights comes after triage.
- Law 23 of 1981, art. 3: the doctor will care for anyone who needs it, with no limits other than those set by law.

## Test yourself

Think of the answer, then tap the question to see it.

## How many triage categories are there in Colombia, and what time does triage II require?

Five categories (Resolution 5596 of 2015); triage II requires care within no more than thirty minutes.

## What principles does WHO propose for allocating scarce resources?

Equality (lottery or first come, first served), best outcomes, priority to the worst off and priority to those who help others; they can be combined according to the degree of scarcity.

## May triage be used to refuse emergency care?

No. Resolution 5596 of 2015 (art. 4, paragraph) expressly forbids it.

## Which Colombian rule sets the criteria for excluding services from public funding?

Statutory Law 1751 of 2015, art. 15.

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## Connections

## Related 4

- [Justice: fair distribution and equal treatment](https://durgical.com/en/medical-ethics/justice-fair-distribution-and-equal-treatment/)
- [Ley Estatutaria 1751 de 2015: health as a fundamental right](https://durgical.com/en/medical-ethics/ley-estatutaria-1751-de-2015-health-as-a-fundamental-right/)
- [Ley 100 de 1993: the general social security health system](https://durgical.com/en/medical-ethics/ley-100-de-1993-the-general-social-security-health-system/)
- [Medical futility and do-not-resuscitate orders](https://durgical.com/en/medical-ethics/medical-futility-and-do-not-resuscitate-orders/)

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Educational content on ethics and health law; not legal advice. Laws and case law change: each page links the official text and says when it was last checked. For a real case, read the text in force and ask a lawyer or the medical ethics tribunal.

Sources: [Coronavirus disease (COVID-19): ethics, resource allocation and priority setting](https://www.who.int/news-room/questions-and-answers/item/coronavirus-disease-covid-19-ethics-resource-allocation-and-priority-setting) (World Health Organization, 2020); [Resolución 5596 de 2015, technical criteria for the emergency triage system](https://www.minsalud.gov.co/Normatividad_Nuevo/Resoluci%C3%B3n%205596%20de%202015.pdf) (Ministerio de Salud y Protección Social, 2015); [Ley Estatutaria 1751 de 2015, art. 15: prestaciones de salud](https://www.funcionpublica.gov.co/eva/gestornormativo/norma.php?i=60733) (Función Pública, Gestor Normativo, 2015).

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/medical-ethics/allocating-scarce-resources-and-triage/