The process of updating the National List of Health Services in Israel: Is it legitimate? Is it fair?

2009 ◽  
Vol 25 (03) ◽  
pp. 255-261 ◽  
Author(s):  
Dan Greenberg ◽  
Miriam I. Siebzehner ◽  
Joseph S. Pliskin
Keyword(s):  
Health Services ◽  
Priority Setting ◽  
New Technologies ◽  
Time Frame ◽  
Priority Setting Process ◽  
Democratic Deliberation ◽  
Accountability For Reasonableness ◽  
Early Adoption ◽  
National Health Insurance Law ◽  
Setting Process

Objective:The Israeli National Health Insurance Law stipulates a National List of Health Services (NLHS) to which all residents are entitled from their HMOs. This list has been updated annually for almost a decade using a structured review and decision-making process. Although this process has been described in detail in previous papers, none of these have fully addressed legitimacy and fairness. We examine the legitimacy and fairness of the process of updating the NLHS in Israel.Methods:We assessed the priority-setting process for compliance with the four conditions of accountability for reasonableness outlined by Daniels and Sabin (relevance, publicity, appeals, and enforcement). These conditions emphasize transparency and stakeholder engagement in democratic deliberation.Results:Our analysis suggests that the Israeli process for updating the NLHS does not fulfill the appeals and enforcement conditions, and only partially follows the publicity and relevance conditions, outlined in the accountability for reasonableness framework. The main obstacles for achieving these goals may relate to the large number of technologies assessed each year within a short time frame, the lack of personnel engaged in health technology assessment, and the desire for early adoption of new technologies.Conclusions:The process of updating the NLHS in Israel is unique and not without merit. Changes in the priority-setting process should be made to increase its acceptability among the different stakeholders.

Implementing accountability for reasonableness – the case of pharmaceutical reimbursement in Sweden

2007 ◽  
Vol 2 (2) ◽  
pp. 153-171 ◽  
Author(s):  
SANDRA JANSSON
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Social Learning ◽  
Priority Setting ◽  
Relative Importance ◽  
Priority Setting Process ◽  
Structured Interviews ◽  
Accountability For Reasonableness ◽  
Setting Process ◽  
A Priority

AbstractThis paper aims to describe the priority-setting procedure for new original pharmaceuticals practiced by the Swedish Pharmaceutical Benefits Board (LFN), to analyse the outcome of the procedure in terms of decisions and the relative importance of ethical principles, and to examine the reactions of stakeholders. All the ‘principally important’ decisions made by the LFN during its first 33 months of operation were analysed. The study is theoretically anchored in the theory of fair and legitimate priority-setting procedures by Daniels and Sabin, and is based on public documents, media articles, and semi-structured interviews. Only nine cases resulted in a rejection of a subsidy by the LFN and 15 in a limited or conditional subsidy. Total rejections rather than limitations gave rise to actions by stakeholders. Primarily, the principle of cost-effectiveness was used when limiting/conditioning or totally rejecting a subsidy. This study suggests that implementing a priority-setting process that fulfils the conditions of accountability for reasonableness can result in a priority-setting process which is generally perceived as fair and legitimate by the major stakeholders and may increase social learning in terms of accepting the necessity of priority setting in health care. The principle of cost-effectiveness increased in importance when the demand for openness and transparency increased.

OP230 How Legitimate Is The Process Of Updating the Benefits Package In Israel? A 20 Year Overview

2020 ◽  
Vol 36 (S1) ◽  
pp. 3-4
Author(s):  
Dan Greenberg ◽  
Yael Assor
Keyword(s):  
Decision Process ◽  
New Technologies ◽  
Time Frame ◽  
Patient Advocate ◽  
The Past ◽  
Accountability For Reasonableness ◽  
Coverage Decision ◽  
National Health Insurance Law ◽  
Appeal Process ◽  
Benefits Package

IntroductionThe National Health Insurance Law enacted in 1995 stipulates a minimum list of health services (benefits package) that the four health plans in Israel have to provide to their members. The recommendations on which new technologies or new indications for existing ones should be added every year to the benefits package, subject to a predetermined budget, are made by a public committee that evaluates and prioritizes candidate technologies according to their clinical merit, economic (mainly budget impact), social, ethical and other aspects. We assessed the legitimacy of this coverage decision process over the past 20 years.MethodsThe legitimacy of the process was assessed by adherence to the conditions outlined in the accountability for reasonableness (A4R) framework. A4R defines four conditions for legitimate and fair healthcare coverage decision processes: relevance, publicity, appeals/reversibility, and enforcement. We reviewed the changes made in the coverage decision process over the past 20 years and examined whether these changes have changed its legitimacy.ResultsOur analysis suggests that despite several changes made over the years in the process for updating the benefits package, for example, increase in transparency, introducing a structured appeal process, it only partially fulfills the four A4R conditions. In order to accomplish these goals more fully, several widely used considerations such as cost-effectiveness analysis and incorporating views from patients should be included. Additionally, this decision-making process should become even more transparent than it currently is.ConclusionsThe annual process of updating the benefits package in Israel where hundreds of technologies are “competing” with each other for coverage under a pre-defined budget is unique and not without merit. This process has been operating in the same pattern with only minor changes made since 1999. The main barriers for fulfilling all A4R conditions may relate in part to the large number of technologies assessed each year within a short time frame. Several changes in the process including the assessment of societal values, involvement of diverse stakeholders including patient advocate groups should be made to improve its legitimacy.

Prioritization of Investments and Disinvestments in Healthcare

2020 ◽  
pp. 124-148
Author(s):  
Julie Sin
Keyword(s):  
Decision Making ◽  
Health Services ◽  
Priority Setting ◽  
Priority Setting Process ◽  
Ethical Considerations ◽  
Setting Process ◽  
Key Concepts ◽  
Decision Making Processes ◽  
Core Components ◽  
Guiding Principles

The chapter looks at the key concepts and issues involved in the prioritization of resources for investments and disinvestments in health services. It describes a framework for understanding what needs to be achieved in this arena. It describes three core components that underpin a coherent approach to prioritization (guiding principles, a tool to help gather and sift through the information, and coherent decision-making processes). The pragmatic overview emphasizes that the processes involved in prioritization matter, and that to do this consistently and with transparency for ethical reasons, as well as to make the task more manageable, is important. An example of a prioritization tool and guiding principles are given. Some ethical considerations in this arena are also discussed. In day-to-day work, many of the issues in this arena can be facilitated by applying the principles, even if a full blown priority setting process is not needed.

scholarly journals Setting priorities in healthcare institutions: The case of McGill University Health Centre

2016 ◽  
Vol 5 (6) ◽  
pp. 38
Author(s):  
Onur Hisarciklilar ◽  
Atish Woozageer ◽  
Afrooz Moatari-Kazerouni ◽  
Andrea Schiffauerova ◽  
Vincent Thomson
Keyword(s):  
Priority Setting ◽  
Health Management ◽  
Health Centre ◽  
Priority Setting Process ◽  
Accountability For Reasonableness ◽  
Setting Process ◽  
Distribution Of Resources ◽  
Mcgill University ◽  
Demand For Health ◽  
Priority Setting Exercise

Priority setting is a decision-making process concerning the distribution of resources. The imbalance between allocated resources and public demand for health services as well as the inherent complexity of healthcare institutions are making priority setting one of the most challenging health management issues. Nevertheless, the priority setting processes and policymaking have not been studied very much at the hospital strategic planning level, i.e., the prioritisation of clinical activities. The purpose of this paper is to provide an evidence based case for improving the priority setting process in large hospitals. In a qualitative case study carried out at the McGill University Health Centre (MUHC), a priority setting exercise is described and the process is assessed in line with an accountability for reasonableness framework. Data collection involved in-depth, one-on-one interviews with key participants, review of key documents, and in-field observation. To assess the priority setting exercise, this paper compares the priority setting process against the five conditions of accountability for reasonableness, and identifies good practices and opportunities for improvement.

scholarly journals Major constraints and trends for common bean production and commercialization; establishing priorities for future research

2014 ◽  
Vol 32 (3) ◽  
pp. 423-431 ◽  
Author(s):  
Jesús José Rodríguez De Luque ◽  
Bernardo Creamer
Keyword(s):  
Common Bean ◽  
Priority Setting ◽  
High Yield ◽  
Future Research ◽  
Priority Setting Process ◽  
Setting Process ◽  
Production And Distribution ◽  
Use Efficiency ◽  
The Caribbean ◽  
Bean Research

In order to identify the principal constraints and trends for common bean production and commercialization and the priorities for future common bean research in Africa, Latin America and the Caribbean (LAC), a priority setting process was developed at the International Center for Tropical Agriculture (CIAT). The results suggested that the principal research included breeding and selecting for several traits, such as drought tolerance and water use efficiency, improved yields, and consumer acceptance (improved cooking time and desired texture after cooking). Additionally, the results of the priority setting process suggested that institutional measures are needed, such as improving formal seed production and distribution channels and the development of national and regional seed policies. On the other hand, the identified principal constraints included diseases, pests, and market constraints. Finally, the identified principal trends were: increase in demand and production, and development of high-yield varieties and improvement in nutritional quality.

scholarly journals Selecting topic areas for developing quality standards in a resource-limited setting

2019 ◽  
Vol 8 (1) ◽  
pp. e000491
Author(s):  
Roongnapa Khampang ◽  
Sarayuth Khuntha ◽  
Phorntida Hadnorntun ◽  
Suthasinee Kumluang ◽  
Thunyarat Anothaisintawee ◽  
...  
Keyword(s):  
Priority Setting ◽  
Quality Standards ◽  
Healthcare Services ◽  
Priority Setting Process ◽  
Deliberative Process ◽  
Mortality And Morbidity ◽  
Stakeholder Consultation ◽  
Healthcare Settings ◽  
Resource Limited ◽  
Setting Process

Variation in practices of and access to health promotion and disease prevention (P&P) across geographical areas have been studied in Thailand as well as other healthcare settings. The implementation of quality standards (QS)—a concise set of evidence-informed quality statements designed to drive and measure priority quality improvements—can be an option to solve the problem. This paper aims to provide an overview of the priority setting process of topic areas for developing QS and describes the criteria used. Topic selection consisted of an iterative process involving several steps and relevant stakeholders. Review of existing documents on the principles and criteria used for prioritising health technology assessment topics were performed. Problems with healthcare services were reviewed, and stakeholder consultation meetings were conducted to discuss current problems and comment on the proposed prioritisation criteria. Topics were then prioritised based on both empirical evidence derived from literature review and stakeholders’ experiences through a deliberative process. Preterm birth, pre-eclampsia and postpartum haemorrhage were selected. The three health problems had significant disease burden; were prevalent among pregnant women in Thailand; led to high mortality and morbidity in mothers and children and caused variation in the practices and service uptake at health facilities. Having agreed-on criteria is one of the important elements of the priority setting process. The criteria should be discussed and refined with various stakeholders. Moreover, key stakeholders, especially the implementers of QS initiative, should be engaged in a constructive way and should be encouraged to actively participate and contribute significantly in the process.

scholarly journals Methodology and criteria for setting national health research priorities in Bhutan: a workshop report

2019 ◽  
Vol 5 (1) ◽  
pp. 38-43
Author(s):  
Debbie L. Humphries ◽  
Hannah Ingber ◽  
Mongal Singh Gurung ◽  
Kaveh Khoshnood
Keyword(s):  
National Health ◽  
Priority Setting ◽  
Health Research ◽  
Research Priorities ◽  
Research Capacity ◽  
Priority Setting Process ◽  
Research Priority ◽  
Research Activities ◽  
Setting Process ◽  
Medical University

The Bhutanese health system is committed to providing health services for all citizens and is interested in strengthening the country’s health research capacity. The objectives of this workshop were to understand the range of health research activities in Bhutan; to formulate a prioritized research agenda for the Ministry of Health (MoH); to share challenges, gaps and opportunities in health research; and to provide insights for future prioritization exercises. The MoH partnered with Khesar Gyalpo University of Medical University of Bhutan and USA-based facilitators to develop and pilot a methodology for health research priority setting.  The Bhutan priority setting process was adapted from the Combined Approach Matrix and the Essential National Health Research methods.  The methodology proved successful in the systematic creation of a list of health research priorities. Future priority setting processes will build on this workshop, continuing to refine and strengthen the priority setting process in Bhutan. 

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