Setting Healthcare Priorities at the Macro and Meso Levels: A Framework for Evaluation.

Edwine W Barasa,Susan Cleary,Mike English,Sassy Molyneux

doi:10.15171/ijhpm.2015.167

Abstract

Priority setting in healthcare is a key determinant of health system performance. However, there is no widely accepted priority setting evaluation framework. We reviewed literature with the aim of developing and proposing a framework for the evaluation of macro and meso level healthcare priority setting practices. We systematically searched Econlit, PubMed, CINAHL, and EBSCOhost databases and supplemented this with searches in Google Scholar, relevant websites and reference lists of relevant papers. A total of 31 papers on evaluation of priority setting were identified. These were supplemented by broader theoretical literature related to evaluation of priority setting. A conceptual review of selected papers was undertaken. Based on a synthesis of the selected literature, we propose an evaluative framework that requires that priority setting practices at the macro and meso levels of the health system meet the following conditions: (1) Priority setting decisions should incorporate both efficiency and equity considerations as well as the following outcomes; (a) Stakeholder satisfaction, (b) Stakeholder understanding, (c) Shifted priorities (reallocation of resources), and (d) Implementation of decisions. (2) Priority setting processes should also meet the procedural conditions of (a) Stakeholder engagement, (b) Stakeholder empowerment, (c) Transparency, (d) Use of evidence, (e) Revisions, (f) Enforcement, and (g) Being grounded on community values. Available frameworks for the evaluation of priority setting are mostly grounded on procedural requirements, while few have included outcome requirements. There is, however, increasing recognition of the need to incorporate both consequential and procedural considerations in priority setting practices. In this review, we adapt an integrative approach to develop and propose a framework for the evaluation of priority setting practices at the macro and meso levels that draws from these complementary schools of thought.

Highlights

Despite recognition of the importance of priority setting in healthcare, priority setting exercises in most settings are ad hoc rather than systematic.[1,2] This has led to calls for strategies to improve priority setting practices in healthcare.[3,4] Essential to improving priority setting practices is having a sense of direction; a standard to be aimed for, and against which to evaluate performance
Based on a synthesis of the selected literature, we propose an evaluative framework that requires that priority setting practices at the macro and meso levels of the health system meet the following conditions: (1) Priority setting decisions should incorporate both efficiency and equity considerations as well as the following outcomes; (a) Stakeholder satisfaction, (b) Stakeholder understanding, (c) Shifted priorities, and (d) Implementation of decisions
On the frequency of recommendation from literature, we propose the following intermediate outcomes to be considered in the evaluation of priority setting practices: (1) Stakeholder satisfaction; the stakeholders should report their satisfaction with the priority setting process adopted, (2) Stakeholder understanding; each stakeholders should demonstrate an understanding of the structure, content and processes of priority setting, and (3) Shifted resources; priority setting practices should result in real movement of resources and reflect change in priorities rather than historical allocations, and (4) Implementation; Priority setting processes should result in the accountable implementation of decisions

Summary

Introduction

Despite recognition of the importance of priority setting in healthcare, priority setting exercises in most settings are ad hoc rather than systematic.[1,2] This has led to calls for strategies to improve priority setting practices in healthcare.[3,4] Essential to improving priority setting practices is having a sense of direction; a standard to be aimed for, and against which to evaluate performance. We conducted an interpretive thematic review of theoretical and empirical literature on and related to the evaluation of priority setting to develop a framework for the evaluation of priority setting practice at the macro (national) and meso (decentralized health systems and health facilities such as hospitals) levels. We aim to contribute to the relatively scarce literature and debate on frameworks for the evaluation of priority setting in healthcare

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Discussion

Conclusion