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Priority Setting (priority + setting)

Distribution by Scientific Domains

Medical Sciences	62%
Life Sciences	12%
Humanities and Social Sciences	12%
Business, Economics, Finance and Accounting	12%

Selected Abstracts

District health systems in a neoliberal world: a review of five key policy areas,

INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue S1 2003
Malcolm Segall
Abstract District health systems, comprising primary health care and first referral hospitals, are key to the delivery of basic health services in developing countries. They should be prioritized in resource allocation and in the building of management and service capacity. The relegation in the World Health Report 2000 of primary health care to a ,second generation' reform,to be superseded by third generation reforms with a market orientation,flows from an analysis that is historically flawed and ideologically biased. Primary health care has struggled against economic crisis and adjustment and a neoliberal ideology often averse to its principles. To ascribe failures of primary health care to a weakness in policy design, when the political economy has starved it of resources, is to blame the victim. Improvement in the working and living conditions of health workers is a precondition for the effective delivery of public health services. A multidimensional programme of health worker rehabilitation should be developed as the foundation for health service recovery. District health systems can and should be financed (at least mainly) from public funds. Although in certain situations user fees have improved the quality and increased the utilization of primary care services, direct charges deter health care use by the poor and can result in further impoverishment. Direct user fees should be replaced progressively by increased public finance and, where possible, by prepayment schemes based on principles of social health insurance with public subsidization. Priority setting should be driven mainly by the objective to achieve equity in health and wellbeing outcomes. Cost effectiveness should enter into the selection of treatments for people (productive efficiency), but not into the selection of people for treatment (allocative efficiency). Decentralization is likely to be advantageous in most health systems, although the exact form(s) should be selected with care and implementation should be phased in after adequate preparation. The public health service should usually play the lead provider role in district health systems, but non-government providers can be contracted if needed. There is little or no evidence to support proactive privatization, marketization or provider competition. Democratization of political and popular involvement in health enhances the benefits of decentralization and community participation. Integrated district health systems are the means by which specific health programmes can best be delivered in the context of overall health care needs. International assistance should address communicable disease control priorities in ways that strengthen local health systems and do not undermine them. The Global Fund to Fight AIDS, Tuberculosis and Malaria should not repeat the mistakes of the mass compaigns of past decades. In particular, it should not set programme targets that are driven by an international agenda and which are achievable only at the cost of an adverse impact on sustainable health systems. Above all the targets must not retard the development of the district health systems so badly needed by the rural poor. Copyright © 2003 John Wiley & Sons, Ltd. [source]

On Being a Good Listener: Setting Priorities for Applied Health Services Research

THE MILBANK QUARTERLY, Issue 3 2003
JONATHAN LOMAS
In the last decade, explicit priority setting has become an integral part of health care systems. Indeed, there is even an International Society on Priorities in Health Care, created in 1997 (Ham 1997). Whether it is Oregon's priority ordering of symptom treatment pairs to maximize the impact of a limited Medicaid budget (Fox and Leichter 1991), England's National Institute for Clinical Excellence's assessing priorities for new therapeutic innovations in the National Health Service (Rawlins 1999), or New Zealand's setting priorities for patients' access to cardiovascular treatment (Hadorn and Holmes 1997), techniques for judging the relative worth of different health service investments abound. As these techniques are refined, the most common addition is the incorporation of public values as part of the assessment. Priority setting is increasingly seen as combining an objective assessment of costs and effects with a more subjective assessment of patient or public preferences (Lenaghan, New, and Mitchell 1996; Lomas 1997; National Institute for Clinical Excellence 2002; Stronks et al. 1997). [source]

Quantification of Extinction Risk: IUCN's System for Classifying Threatened Species

CONSERVATION BIOLOGY, Issue 6 2008
GEORGINA M. MACE
definición de prioridades de conservación; especies amenazadas; Lista Roja UICN; riesgo de extinción Abstract:,The International Union for Conservation of Nature (IUCN) Red List of Threatened Species was increasingly used during the 1980s to assess the conservation status of species for policy and planning purposes. This use stimulated the development of a new set of quantitative criteria for listing species in the categories of threat: critically endangered, endangered, and vulnerable. These criteria, which were intended to be applicable to all species except microorganisms, were part of a broader system for classifying threatened species and were fully implemented by IUCN in 2000. The system and the criteria have been widely used by conservation practitioners and scientists and now underpin one indicator being used to assess the Convention on Biological Diversity 2010 biodiversity target. We describe the process and the technical background to the IUCN Red List system. The criteria refer to fundamental biological processes underlying population decline and extinction. But given major differences between species, the threatening processes affecting them, and the paucity of knowledge relating to most species, the IUCN system had to be both broad and flexible to be applicable to the majority of described species. The system was designed to measure the symptoms of extinction risk, and uses 5 independent criteria relating to aspects of population loss and decline of range size. A species is assigned to a threat category if it meets the quantitative threshold for at least one criterion. The criteria and the accompanying rules and guidelines used by IUCN are intended to increase the consistency, transparency, and validity of its categorization system, but it necessitates some compromises that affect the applicability of the system and the species lists that result. In particular, choices were made over the assessment of uncertainty, poorly known species, depleted species, population decline, restricted ranges, and rarity; all of these affect the way red lists should be viewed and used. Processes related to priority setting and the development of national red lists need to take account of some assumptions in the formulation of the criteria. Resumen:,La Lista Roja de Especies Amenazadas de la UICN (Unión Internacional para la Conservación de la Naturaleza) fue muy utilizada durante la década de l980 para evaluar el estatus de conservación de especies para fines políticos y de planificación. Este uso estimuló el desarrollo de un conjunto nuevo de criterios cuantitativos para enlistar especies en las categorías de amenaza: en peligro crítico, en peligro y vulnerable. Estos criterios, que se pretendía fueran aplicables a todas las especies excepto microorganismos, eran parte de un sistema general para clasificar especies amenazadas y fueron implementadas completamente por la UICN en 2000. El sistema y los criterios han sido ampliamente utilizados por practicantes y científicos de la conservación y actualmente apuntalan un indicador utilizado para evaluar el objetivo al 2010 de la Convención de Diversidad Biológica. Describimos el proceso y el respaldo técnico del sistema de la Lista Roja de la IUCN. Los criterios se refieren a los procesos biológicos fundamentales que subyacen en la declinación y extinción de una población. Pero, debido a diferencias mayores entre especies, los procesos de amenaza que los afectan y la escasez de conocimiento sobre la mayoría de las especies, el sistema de la UICN tenía que ser amplio y flexible para ser aplicable a la mayoría de las especies descritas. El sistema fue diseñado para medir los síntomas del riesgo de extinción, y utiliza cinco criterios independientes que relacionan aspectos de la pérdida poblacional y la declinación del rango de distribución. Una especie es asignada a una categoría de amenaza si cumple el umbral cuantitativo por lo menos para un criterio. Los criterios, las reglas acompañantes y las directrices utilizadas por la UICN tienen la intención de incrementar la consistencia, transparencia y validez de su sistema de clasificación, pero requiere algunos compromisos que afectan la aplicabilidad del sistema y las listas de especies que resultan. En particular, se hicieron selecciones por encima de la evaluación de incertidumbre, especies poco conocidas, especies disminuidas, declinación poblacional, rangos restringidos y rareza; todas estas afectan la forma en que las listas rojas deberían ser vistas y usadas. Los procesos relacionados con la definición de prioridades y el desarrollo de las listas rojas nacionales necesitan considerar algunos de los supuestos en la formulación de los criterios. [source]

Values and technology assessmentin psychiatry

ACTA PSYCHIATRICA SCANDINAVICA, Issue 399 2000
T. Nilstun
Economic resources for health care are limited and they should be distributed as fairly and effectively as possible. But the basis for such a distribution is far from clear. What interests are involved? What kind of provision of care is most efficient? How far should the distribution be left to market solutions? What is the proper role of health care politicians and authorities? In technology assessment a promising combination of value premises and empirical knowledge is used in answering such questions. The aim of this introductory article is to explore issues related to values and value conflicts that have implications for technology assessment. Ethical principles are discussed and related to problematic issues in mental health care such as the absence of psychiatry, the abuse of psychiatry, the definition of mental illness, diagnostic activities, treatment decisions, priority setting as well as research and development. [source]

Planning Environmental Sanitation Programmes in Emergencies

DISASTERS, Issue 2 2005
Peter A. Harvey
Environmental sanitation programmes are vital for tackling environmental-related disease and ensuring human dignity in emergency situations. If they are to have maximum impact they must be planned in a rapid but systematic manner. An appropriate planning process comprises five key stages: rapid assessment and priority setting; outline programme design; immediate action; detailed programme design; and implementation. The assessment should be based on carefully selected data, which are analysed via comparison with suitable minimum objectives. How the intervention should be prioritised is determined through objective ranking of different environmental sanitation sector needs. Next, a programme design outline is produced to identify immediate and longer-term intervention activities and to guarantee that apposite resources are made available. Immediate action is taken to meet acute emergency needs while the detailed programme design takes shape. This entails in-depth consultation with the affected community and comprehensive planning of activities and resource requirements. Implementation can then begin, which should involve pertinent management and monitoring strategies. [source]

Managing the entry of new medicines in the National Health Service: health authority experiences and prospects for primary care groups and trusts

HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 6 2001
Ruth McDonald BA MSc PhD
Abstract For the most part, the management of new medicines in the NHS has hitherto been a matter for local discretion. The result is that access to medicines is often determined by where a patient lives, as opposed to some nationally agreed clinical criteria. This ,postcode prescribing' has led to widespread variations in access to medicines and concerns about the resulting inequalities. Primary care groups and trusts are expected to reduce variations in access to care, whilst at the same time balancing their finances, since any overspends on prescribing must be covered by disinvestment in hospital and community services. We interviewed 21 health authority (HA) prescribing advisers to ascertain how they viewed the managed entry of new medicines in order to identify lessons for PCGs. In addition, we report the views of local prescribing managers on the potential impact of recent government policy changes on the process and speculate on the likely implications of these for primary care groups and trusts. What is clear from the study is that HAs often have no explicit objective in relation to new medicines, but that their desire to act is prompted by fears of overspending on prescribing budgets. The danger of this approach is that patients may be denied cost-effective treatments since all new medicines are seen as a problem. It seems likely that PCG/Ts will face the same dilemmas with which the HA advisers in our study have been wrestling for some time. Recent policy changes in relation to prescribing budgets and new medicines are likely to exacerbate these problems. The tensions between local priority setting, which may mean saying no to new medicines, whilst at the same time eradicating postcode prescribing and balancing budgets means that PCG/Ts face difficult policy choices. [source]

The efficiency frontier approach to economic evaluation of health-care interventions

HEALTH ECONOMICS, Issue 10 2010
J. Jaime Caro
Abstract Background: IQWiG commissioned an international panel of experts to develop methods for the assessment of the relation of benefits to costs in the German statutory health-care system. Proposed methods: The panel recommended that IQWiG inform German decision makers of the net costs and value of additional benefits of an intervention in the context of relevant other interventions in that indication. To facilitate guidance regarding maximum reimbursement, this information is presented in an efficiency plot with costs on the horizontal axis and value of benefits on the vertical. The efficiency frontier links the interventions that are not dominated and provides guidance. A technology that places on the frontier or to the left is reasonably efficient, while one falling to the right requires further justification for reimbursement at that price. This information does not automatically give the maximum reimbursement, as other considerations may be relevant. Given that the estimates are for a specific indication, they do not address priority setting across the health-care system. Conclusion: This approach informs decision makers about efficiency of interventions, conforms to the mandate and is consistent with basic economic principles. Empirical testing of its feasibility and usefulness is required. Copyright © 2010 John Wiley & Sons, Ltd. [source]

Towards a multi-criteria approach for priority setting: an application to Ghana

HEALTH ECONOMICS, Issue 7 2006
Rob Baltussen
Abstract Background: Many criteria have been proposed to guide priority setting in health, but their relative importance has not yet been determined in a way that allows a rank ordering of interventions. Methods: In an explorative study, a discrete choice experiment was carried out to determine the relative importance of different criteria in identifying priority interventions in Ghana. Thirty respondents chose between 12 pairs of scenarios that described interventions in terms of medical and non-medical criteria. Subsequently, a composite league table was constructed to rank order a set of interventions by mapping interventions on those criteria and considering the relative weights of different criteria. Results: Interventions that are cost-effective, reduce poverty, target severe diseases, or target the young had a higher probability of being chosen than others. The composite league table showed that high priority interventions in Ghana are prevention of mother to child transmission in HIV/AIDS control, and treatment of pneumonia and diarrhoea in childhood. Low priority interventions are certain interventions to control blood pressure, tobacco and alcohol abuse. The composite league table lead to a different and more differentiated rank ordering of interventions compared to pure efficiency ratings. Conclusion: This explorative study has introduced a multi-criteria approach to priority setting. It has shown the feasibility of accounting for efficiency, equity and other societal concerns in prioritization decisions, and its potentially large impact on priority setting. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Matching Technologies with Potential End Users: A Knowledge Engineering Approach for Agricultural Research Management

JOURNAL OF AGRICULTURAL ECONOMICS, Issue 1 2004
J. David Reece
This paper addresses the problem of priority setting that faces developing country agricultural research, a problem whose relevance has been sharpened by the current context of demands for greater efficiency and targeted impact. A new method for ex ante estimation of the impact of developing each of several alternative proposed technologies is described and illustrated through an example from West Africa. This method is based on the notion of market segmentation, which normally makes intensive use of secondary data-sets that are simply not available for rural areas of developing countries. To circumvent this lack of secondary data, the method adopts a knowledge engineering approach based on the views of an expert panel familiar with the region to be served. Descriptions of proposed technologies are matched with the interests and resources of identified market segments, together with the characteristics of their farming systems and locations, to identify those segments whose members are likely to use the proposed technology. Further development of the method is discussed. [source]

Health Care Need: Three Interpretations

JOURNAL OF APPLIED PHILOSOPHY, Issue 2 2006
ANDREAS HASMAN
abstract The argument that scarce health care resources should be distributed so that patients in ,need' are given priority for treatment is rarely contested. In this paper, we argue that if need is to play a significant role in distributive decisions it is crucial that what is meant by need can be precisely articulated. Following a discussion of the general features of health care need, we propose three principal interpretations of need, each of which focuses on separate intuitions. Although this account may not be a completely exhaustive reflection of what people mean when they refer to need, the three interpretations provide a starting-point for further debate of what the concept means in its specific application. We discuss combined interpretations, the meaning of grading needs, and compare needs-based priority setting to social welfare maximisation. [source]

Understanding future ecosystem changes in Lake Victoria basin using participatory local scenarios

AFRICAN JOURNAL OF ECOLOGY, Issue 2009
Eric O. Odada
Abstract Understanding future ecosystem changes is central to sustainable natural resource management especially when coupled with in-depth understanding of impacts of drivers, such as governance, demographic, economic and climate variations and land use policy. This offers comprehensive information for sustainable ecosystem services provision. A foresight process of systematic and presumptive assessment of future state and ecosystem integrity of Lake Victoria basin, as participatory scenario building technique, is presented. Four scenarios have been illustrated as possible future states of the basin over the next twenty years. Using a scenario building model developed in Ventana Simulation (VENSIM®) platform, the paper presents a scenario methodology for tracking changes in lake basin ecosystem status. Plausible trends in land use change, changes in lake levels and contribution of fisheries are presented. This is part of an initial attempt to setup long-term environmental policy planning strategies for Lake Victoria basin. The assumptions, driving forces, impacts and opportunities under each scenario depict major departure and convergence points for an integrated transboundary diagnosis and analysis of regional issues in the basin as well as strategic action planning for long-term interventions. The findings have been presented in terms of temporal, spatial, biophysical and human well-being dimensions. The attempts in this study can be embedded in a policy framework for basin management priority setting and may guide partnerships for environmental management. [source]

Waiting for scheduled services in Canada: development of priority-setting scoring systems

JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2003
T. W. Noseworthy MD MSc MPH FRCPC FACP FCCP FCCM CHE
Abstract Rationale, aims and objectives An Achilles' heel of Canadian Medicare is long waits for elective services. The Western Canada Waiting List (WCWL) project is a collaboration of 19 partner organizations committed to addressing this issue and influencing the way waiting lists are structured and managed. The focus of the WCWL project has been to develop and refine practical tools for prioritizing patients on scheduled waiting lists. Methods Scoring tools for priority setting were developed through extensive clinical input and highly iterative exchange by clinical panels constituted in five clinical areas: cataract surgery; general surgery procedures; hip and knee replacement; magnetic resonance imaging (MRI) scanning, and children's mental health. Several stages of empirical work were conducted to formulate and refine criteria and to assess and improve their reliability and validity. To assess the acceptability and usability of the priority-setting tools and to identify issues pertaining to implementation, key personnel in the seven regional health authorities (RHAs) participated in structured interviews. Public opinion focus groups were conducted in the seven western cities. Results Point-count scoring systems were constructed in each of the clinical areas. Participating clinicians confirmed that the tools offered face validity and that the scoring systems appeared practical for implementation and use in clinical settings. Reliability was strongest for the general surgery and hip and knee criteria, and weakest for the diagnostic MRI criteria. Public opinion focus groups endorsed wholeheartedly the application of point-count priority measures. Regional health authorities were generally supportive, though cautiously optimistic towards implementation. Conclusions While the WCWL project has not ,solved' the problem of waiting lists and times, having a standardized, reliable means of assigning priority for services is an important step towards improved management in Canada and elsewhere. [source]

Exploring strategic priorities for regional agricultural R&D investments in East and Central Africa

AGRICULTURAL ECONOMICS, Issue 2 2010
Liangzhi You
O13; O32; O55; Q16 Abstract The 11 countries of East and Central Africa have diverse but overlapping agroclimatic conditions, and could potentially benefit from spillovers of agricultural technology across country borders. This article uses high-resolution spatial data on actual and potential yields for 15 major products across 12 development domains to estimate the total benefits available from the spread of new agricultural technologies around the region. Market responses and welfare gains are estimated using the,Dynamic Research Evaluation for Management,model, taking account of current and future projections of local and international demand. Results suggest which crops, countries, and agroclimatic regions offer the largest total benefits. Downloadable data and program files permit different assumptions and additional information to be considered in the ongoing process of strategic priority setting. [source]

Doctors' professional values: results from a cohort study of United Kingdom medical graduates

MEDICAL EDUCATION, Issue 8 2001
Lorelei Cooke
Objectives To examine young doctors' views on a number of professional issues including professional regulation, multidisciplinary teamwork, priority setting, clinical autonomy and private practice. Method Postal survey of 545 doctors who graduated from United Kingdom medical schools in 1995. Results Questionnaires were returned by 95% of the cohort (515/545). On issues of professional regulation, teamwork and clinical autonomy, the majority of doctors held views consistent with current General Medical Council guidance. The majority supported the right of doctors working in the NHS to engage in private practice. Most respondents thought that public expectations of doctors, medicine and the NHS were too high, and that some form of rationing was inevitable. On many issues there was considerable variation in attitudes on the basis of sex and intended branch of medicine. Conclusions The results highlight the heterogeneity of the profession and the influence of specialty and gender on professional values. Doctors' attitudes had also been shaped by broader social changes, especially debates surrounding regulation of the profession, rising public expectations and the need for rationing of NHS care. [source]