PHS124 - How Values Inform the Health Policy Decision-Making Processes About Health-System Financing in Latin America? A Critical Interpretive Synthesis

Abstract

To understand how and under what conditions societal values inform decisions about health system financing in Latin American (LA) countries. A critical interpretive synthesis approach was utilized for this work. We searched 17 databases in December 2016 to identify all empirical and non-empirical articles written in English, Spanish or Portuguese that focus on values that inform the policy process for health-system financing in LA countries at macro and meso levels. Two reviewers independently screened records and assessed for inclusion. One researcher conceptually mapped included articles, created structured summaries of key findings from each; and selected a purposive sample of articles to thematically synthetize the results across the domains: agenda setting/prioritization, policy development and implementation. We identified 5925 references, included 199 papers, and synthetized 68 papers. Articles were focused on health systems of countries in Central America (n=36), South America (n=81), Central and South America (n=13) or with a general scope in LA (n=69). We identified 116 values, and developed a framework to explain how values have been used to inform policy decisions about financing in LA. This framework has four categories: 1) goal-related values (i.e. guiding principles of the health system); 2) technical values (those incorporated into the instruments adopted by policymakers to ensure a sustainable and efficient health system); 3) governance values (those applied in the policy process to ensure a transparent and accountable process of decision-making); 4) situational values (a broad category of values that represent competing strategies to make decisions in the health systems, their influence vary according to four factors). This review and the framework that emerged from the analysis, are an effort to consolidate and explain how different social values are taken into consideration and support the policy decision-making about health system financing in Latin America.