Professional Documents
Culture Documents
Clinic Director
X has set up a clinic around Avonhead (an upscale yet recent immigrant dense neighbourhood). The population that the clinic serves is aging (60% above 65 years and 40% are young families (35 years average age with two kids). X wants to set up a suite of services to offer to this community but has resource limitations. What mix of services you will advise him?
Range of Services
Y is a consultant and wants to work in areas of public health and preventive health services at a rural township where a large farming community exists. The average age of the population is about 55 years, most are locally based farmers, or work in sheep shearing sheds, or have work with farming machineries. With Limited Budget, what kind of services would you advise Y to plan for?
Dilemma
Imagine you have only $1000 to spare to pay for treatment Who will get treatment?
$1000 to Spend
Child with appendicitis needs an urgent surgery, overall cost $1000 out of your pocket
You need to get a root canal treatment done for a cavity in your tooth
Sustainability of healthcare systems is threatened by a growing demand for services and availability of expensive innovative technologies.
Trip Up Points
Multiplicity of priorities and Lack of institutional mechanisms to rationalize services and spending often results in Poor overall system performance, Low coverage for highly cost-effective health technologies
Alternatives to Prioritization
Add More Resources Take out Services
Challenges of Prioritization
Resources are limited Impossible to provide everyone with every effective intervention Limited resources and unlimited demands Justice and efficiency Lack of Consensus Little interaction about priority setting among decision makers
Controversies of Prioritization
Process Affects Who, What, How Much, When, and at What Cost Donors want to see their investments incorporated into public budgets No simple or purely technical answers Uncertainties around which values should guide decisions about Prioritization
Risk Pooling
Some health conditions are rare and too costly for most uninsured individuals to pay out-of-pocket
Frameworks
Frameworks Are Necessary Explicit Processes != Haphazard Rationing Ethical Issues Can be Addressed Inevitable Policy and Implementation Issues localized Helps to Choose Among Alternative Treatments
Available Frameworks
A4R Framework PBMA Framework Sibbalds Framework 7+7 framework seven principles and processes
PBMA Framework
Program budgeting and marginal analysis (PBMA) is an economic framework specifically designed to help local decision makers set health service priorities While making decisions between competing claims on scarce health service resources, economic tools and thinking have much to offer. In particular, decision making should explicitly consider opportunity cost and the margin. Recent evidence shows that decision makers both understand these economic principles and would like to use economic tools in setting priorities The intent of PBMA is to assist local decision makers in directing resources to maximize benefits from health services, considering both opportunity cost and resource shifts at the margin
Sibbalds Framework
Explicit Process Consideration of Context and Values Stakeholder Engagement Transparency Effective and Efficient Information Management Revision or Appeals Mechanism Positive Externalities Externalities may include positive media coverage (which can contribute to public dialogue, social learning, and improved decision making in subsequent iterations of priority setting), peeremulation or health sector recognition (e.g. by other health care organizations, accreditation bodies, etc), changes in policies, and potentially changes to legislations or practice
7 by 7 Framework
Priority setting should be scientifically rigorous, transparent, consistent, independent from vested interests, contestable, timely, and enforceable. Standardize Registration Select and Scope Topics based on Evidence Assess Budget Impacts Allow for Appeals, Tracking, and Evaluation Conduct Cost Effectiveness Use Deliberative Processes Decide Consistently
Best Practices
Use recent data Analysis should be country specific Be based on a well functioning and representative set of information systems Rank Order by Burden and by population subgroup in order to provide useful advocacy information for the different groups Build Flexibility in Budget Build Linkages across services Ensure Sufficient time and resources to deliver the interventions
Role of Losers
Group of people that inevitably will get less, in terms of benefits or services, than others Policy Attention Usually paid to the groups in society that make the loudest noise about their perceived needs. Those segments of society that have the least voice or political influence are likely to be the ones that receive the least attention