Abstract
Purpose: To describe and evaluate priority setting in an Acute Care hospital in Argentina, using Accountability for Reasonableness, an ethical framework for fair priority setting. Methods: Case Study involving key informant interviews and document review. Thirty respondents were identified using a snowball sampling strategy. A modified thematic approach was used in analyzing the data. Results: Priorities are primarily determined at the Department of Health. The committee which is supposed to set priorities within the hospital was thought not to have much influence. Decisions were based on government policies and objectives, personal relationships, economic, political, historical and arbitrary reasons. Decisions at the DOH were publicized through internet; however, apart from the tenders and a general budget, details of hospital decisions were not publicized. CATA provided an accessible but ineffective forum for appeals. There were no clear mechanisms for appeals and leadership to ensure adherence to a fair process. Conclusions: In spite of their efforts to ensure fairness, Priority setting in the study hospital did not meet all the four conditions of a fair process. Policy discussions on improving legitimacy and fairness provided an opportunity for improving fairness in the hospital and Accountability for Reasonableness might be a useful framework for analysis and for identifying and improving strategies.
Highlights
Priority setting in Latin America has become one of the most discussed issues within the government and among public administration scholars, especially because of the sweeping health system reforms across the region[1]
The economic crisis experienced by Argentina in December 2001 transformed a nation once regarded as an economic success guided by democratic stability into a state marred by financial collapse, corruption and descent into the deepest depression in its history
This paper describes priority setting in an acute care municipal level public hospital in Buenos Aires, examines how closely current practice at a leading public hospital reflects the academic and policy discourse and evaluates the priority setting process using an ethical framework for fair processes
Summary
Priority setting in Latin America has become one of the most discussed issues within the government and among public administration scholars, especially because of the sweeping health system reforms across the region[1]. Policy making has become too personalistic, too political and too unregulated[2,3,4,5] To address these challenges within the health sector the newest wave of scholarly work in priority setting in Argentina stresses the necessity of evidence-based decision as seen in the national conference proceedings on health economics and national health policy in 2003(6). This emphasis has changed significantly since the 2000 health and economics conference, which focused on health outcomes and equity[7]. There has been a discussion of the necessary administrative and management technologies required to guide complex decision making essential in today’s urban hospitals[4,12]
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