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 Evidence-based priority setting

2001 ◽  
Vol 24 (2) ◽  
pp. 32 ◽  
Author(s):  
Julie Astley ◽  
Wendy Wake-Dyster
Keyword(s):  
Decision Making ◽  
Resource Allocation ◽  
Priority Setting ◽  
Evidence Based ◽  
Priority Setting Process ◽  
Marginal Analysis ◽  
Community Values ◽  
Setting Process ◽  
Combine Program ◽  
Program Budgeting

This paper describes evidence-based priority setting and resource allocation undertaken by a Division of the Women's & Children's Hospital, Adelaide during 1998-1999. We describe the methods used to combine program budgeting marginal analysis (PBMA), evidence based and "community values" approaches into one decision-making framework.Previous organisational changes involving the formation of multidisciplinary team and program management were pivotal in setting a framework to successfully complete the priority setting process.

What Really Sets Priorities?

2019 ◽  
pp. 45-66
Author(s):  
Jesse B. Bump
Keyword(s):  
Decision Making ◽  
Global Health ◽  
Priority Setting ◽  
State Capacity ◽  
Historical Analysis ◽  
The State ◽  
Priority Setting Process ◽  
Methods Of Analysis ◽  
Setting Process ◽  
Participatory Processes

The practice of priority-setting in global health has evolved to include both helpful strengths and extraordinary weaknesses. This chapter explores how context and methods shape the priority-setting process and influence its outcomes through an historical analysis of four cases of decision-making about cholera and diarrheal diseases: in Jamaica in 1850, in London in 1866, by multilateral development agencies in the 1980s, and by Gavi, the Vaccine Alliance in 2006. The chapter focuses on the nature of the state–citizen relationship, the type of evidence used, the methods of analysis employed, and the identity of those whose judgment is applied to explain variation in decision-making. Analyzing these examples suggests that priority-setting has evolved to become a narrow exercise incapable of reckoning broader problems, ill suited to assessing comprehensive solutions, and unlikely to contribute to the development of state capacity. Taken together, these findings argue for rethinking priority-setting methods to better account for a wider range of problems, more participatory processes, and more comprehensive solutions.

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.

Evaluation in Nature Conservation Decision-making

1984 ◽  
Vol 11 (3) ◽  
pp. 247-252 ◽  
Author(s):  
Nigel J. Roome
Keyword(s):  
Decision Making ◽  
Nature Conservation ◽  
Priority Setting ◽  
Conservation Priorities ◽  
Priority Setting Process ◽  
Conservation Priority ◽  
Ecological Evaluation ◽  
Ecological Features ◽  
Setting Process ◽  
Evaluation Techniques

This paper considers alternative approaches to the evaluation of Nature conservation resources as part of the overall process of establishing Nature conservation priorities. The techniques available for evaluation are seen to differ in their ideological base and methodology, and in the relative importance which they attach to physical and ecological features. This lack of consistency means that existing techniques only represent a partial basis for determining conservation priorities. Furthermore, the assumptions on which evaluation techniques are based tend not to be stated explicitly and often appear not to have been substantiated. These inconsistencies are due in part to ambiguity concerning the objectives of conservation, in part to the lack of research into the relationship between human demands and the features of Nature conservation resources, and in part to uncertainty as to the position of evaluation in the conservation priority-setting process.A model of this process for setting conservation priorities is presented. It delimits ecological evaluation as an objective, value-free element in the priority-setting process—where ecological evaluation is seen to provide information which aids decision-makers in the more value-laden socio-economic elements of conservation priority-setting. The model implies that the objective and subjective elements in existing evaluation techniques are not sufficiently explicit to ensure consistency in decision-making.

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.

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 Introducing health technology assessment in Tanzania

2019 ◽  
Vol 36 (2) ◽  
pp. 80-86 ◽  
Author(s):  
Gavin Surgey ◽  
Kalipso Chalkidou ◽  
William Reuben ◽  
Fatima Suleman ◽  
Jacqui Miot ◽  
...  
Keyword(s):  
Decision Making ◽  
Health Technology Assessment ◽  
Low Income ◽  
Priority Setting ◽  
Technology Assessment ◽  
Health Technology ◽  
Sub Saharan Africa ◽  
Essential Medicines ◽  
Revision Process ◽  
Decision Making Processes

AbstractObjectivesHealth technology assessment (HTA) is a cost-effective resource allocation tool in healthcare decision-making processes; however, its use is limited in low-income settings where countries fall short on both absorptive and technical capacity. This paper describes the journey of the introduction of HTA into decision-making processes through a case study revising the National Essential Medicines List (NEMLIT) in Tanzania. It draws lessons on establishing and strengthening transparent priority-setting processes, particularly in sub-Saharan Africa.MethodsThe concept of HTA was introduced in Tanzania through revision of the NEMLIT by identifying a process for using HTA criteria and evidence-informed decision making. Training was given on using economic evidence for decision making, which was then put into practice for medicine selection for the NEMLIT. During the revision process, capacity-building workshops were held with reinforcing messages on HTA.ResultsBetween the period 2014 and 2018, HTA was introduced in Tanzania with a formal HTA committee being established and inaugurated followed by the successful completion and adoption of HTA into the NEMLIT revision process by the end of 2017. Consequently, the country is in the process of institutionalizing HTA for decision making and priority setting.ConclusionWhile the introduction of HTA process is country-specific, key lessons emerge that can provide an example to stakeholders in other low- and middle-income countries (LMICs) wishing to introduce priority-setting processes into health decision making.

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.

Development of Project Priority-Setting Methodology for Pennsylvania's Airport Development Program

1996 ◽  
Vol 1562 (1) ◽  
pp. 19-27
Author(s):  
James T. Cullison ◽  
Gary L. Gittings
Keyword(s):  
Decision Making ◽  
Priority Setting ◽  
Public Involvement ◽  
Evaluation Criteria ◽  
Development Program ◽  
Analysis Procedure ◽  
Metropolitan Planning ◽  
Criteria Weights ◽  
Guiding Principles ◽  
Decision Making Tool

The methodology used to develop a decision making tool for choosing among candidate projects for a state airport development program is presented. The approach emphasized public involvement and cooperation, using a panel of experts from the aviation community to establish guiding principles, select the analysis procedure, develop evaluation criteria, and choose criteria weights for the new priority-setting model. The panel included airport managers, metropolitan planning organization aviation planners, aviation consultants, and state aviation planners.

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