ReviewHow have systematic priority setting approaches influenced policy making? A synthesis of the current literature
Section snippets
Introduction/Background
Priority setting, (PS), a process involving decision making about the allocation of resources between the competing claims of different services, different patient groups or different elements of care [1], is one of the most critical health policy challenge because of the gap between the increasing population health demands and needs and the resources that should meet them [2]. Several priority setting frameworks have been developed to provide guidance for the policy makers who have to make
Methods
This was a scoping literature review. Our sources of literature included PubMed and Ovid databases (including Embase, Global Health, Medline, PsycINFO). We searched for peer-reviewed literature on priority setting in health care published between January 2000 and March 2017. Search terms included “priority setting”, “resource allocation”, “health care”, “health systems”, “health interventions”, “approaches”, “initiatives” and “frameworks”. Subsequent searches involved a combination of the
Data extraction and synthesis
The following steps were followed;
- i)
Developing the data extraction tool: LK & SDR developed the data extraction tool based on the relevant themes namely; name of the framework, countries and level of application; priority setting case, health issue or health program; paper type; decision maker satisfaction or perception of the utility of the approach, whether or not the framework/priorities influenced policy making.
- ii)
Data extraction: Using the data extraction tool, SDR read through the selected
Results
This section is organised according to the frameworks. For each framework there is a description of the framework and the reported country/region and level of its application, an assessment of ‘decision maker perspectives on its utility, and whether or not the framework is reported to have impacted policy or to have been adopted for routine policy making (Table 4).
Program budgeting and marginal analysis (PBMA)
The program budgeting and marginal analysis (PBMA) approach relies on two fundamental economic principles in its approach to priority setting: opportunity cost and marginal analysis [11]. The notion of opportunity cost implies that if resources are invested in one area, there are benefits that are given up in another area. Marginal analysis is concerned with the last unit of production of any two or more given programs. Marginal analysis allows decision makers to identify the best mix of
Multi-criteria decision analysis (MCDA)
We retrieved and reviewed twenty papers that described the application of the Multi- criteria decision analysis (MCDA) approach. Multi-criteria decision analysis facilitates the use of multiple explicit criteria in priority setting [4]. The process consists of four steps: 1) identifying policy criteria and metrics; 2) identifying a series of alternatives based on various combinations of policy criteria; 3) measuring performance of alternatives by criteria (through discrete choice experiment
Accountability for reasonableness
Accountability for reasonableness (A4R), is an ethics-based, and process-driven framework that focuses on ensuring that the priority setting process is fair [59]. According to this framework, a fair PS process should fulfill four conditions namely: Publicity: both the decisions and rationales of used in PS must be made publicized; Relevance: the rationales that guide the PS process must be considered to be relevance by “fair-minded” people in the context in which the framework is being applied;
Burden of disease and cost-effectiveness analysis (BOD & CEA)
The BOD/CEA approach was first introduced in the World Bank’s World Development Report of 1993, ‘Investing in Health’ [85]. In this approach, effectiveness is evaluated based on both mortality and morbidity data, under a composite measure; the Disability Adjusted Life Year (DALYs) [86]. DALYs are then used in CEA, whereby interventions with the most favorable cost-effectiveness ratio are prioritized. In many contexts, the most cost- effective interventions comprise the essential or basic health
Discussion
While there is a wealth of literature on approaches to priority setting, there is a paucity of synthesizes of the current literature to assesses the degree to which the approaches that have been developed to guide priority setting have influenced policy making and have been institutionalized. This paper filled this gap.
There were relatively limited peer review publications reporting on the degree to which all the approaches have influenced policy making and have been institutionalized. Although
Conclusion
This review found that while the intention of developing the priority setting approaches is for them to eventually be used to guide routine policy making, to date, not many have been integrated into routine practice. Sited limitations included technical complexity of the approaches and the resource requirements. Conversely, although some approaches, e.g. BOD/CEA, were perceived to be complex by some stakeholders, they have been integrated into routine policy making. This could be explained by
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2020, Health PolicyCitation Excerpt :The fact that the stipulations of the frameworks are not being followed may reflect that many of the included studies were research projects. Feasibility of comprehensive stakeholder participation that includes not only the powerful stakeholders, but also publics and vulnerable groups, can be limited in the context of a research project rather than implementation of the frameworks in actual policymaking contexts [18,23]. Disconnects between the foundational papers and applications of the frameworks may also point to some practical limitations of public participation.