Setting health priorities: a review of concepts and approaches

Priority Setting in the Polish Health Care System According to Patients' Perspective

Identification of health priorities is concerned with equitable distribution of resources and is an important part of strategic planning in the health care system. The aim of this article is to describe health priorities in the Polish health care system from the patients’ perspective. The study included 533 patients hospitalized in the Lodz region. The average age of the respondents was 48.5 years and one third (36.6%) had university education. Most of the respondents (64.9%) negatively assessed the functioning of the health care system in Poland. Most of them claimed the following aspects require improvements: financing health services (85.8%), determining priorities in health care (80.3%), the role of health insurance (80.3%), and medical education (70.8%). Over 70% of the respondents agreed the role of politicians in designing and implementing health system reforms should be limited. The fact that the respondents so negatively assessed the Polish health care system implies there is a need for full discussion on redefining health priorities.

How Do Allied Health Professionals Define and Apply Equity When Making Resource Allocation Decisions?

An ethnographic study was conducted in 2 stages to understand how allied health professionals define and apply equity when making resource allocation decisions. Participants were allied health managers and clinicians from Victoria, Australia. Stage 1 included 4 semi-structured forums that incorporated real-life case studies, group discussions, and hypothetical scenarios. The project's steering committee began a thematic analysis during post-forum discussions. Stage 2 included a key stakeholder working party that further discussed the concept of equity. The forum recordings were transcribed verbatim, and a detailed thematic analysis ensured the initial thematic analysis was complete. Several domains of equity were discussed. Participants would readily identify that equity was a consideration when making resource decisions but were generally silent for a prolonged period when prompted to identify what they meant when using this term. The findings indicate that asking allied health professionals to directly state how they define and apply equity to their decision-making could be too difficult a task, as this did not elicit rich and meaningful discussions. Future research should examine individual domains of equity when applied to resource allocation decisions.

Diarrhoeal diseases and the global health agenda: measuring and changing priority

We investigate priority setting and the global health agenda by analysing the control of diarrhoeal diseases (CDD). CDD was one of the 'twin engines' of the 1980s' child survival movement, but now has a low priority on the global health agenda, even though diarrhoeal diseases still claim around 1.5 million children annually. In this article, we develop a framework and four indicators of priority to measure CDD's overall prominence on the global health agenda over the last three decades: trends in treatment coverage, changes in perceived priority, changes in financial support and institutional involvement and bibliographic trends. We find that CDD's priority is now one-sixth to one-third of its level in 1985. We then use political analysis to suggest strategies for reframing CDD as an issue and promoting its priority on the global health agenda.

Unmet needs of persons with cancer in Pennsylvania during the period of terminal care

A stratified random sample of recent cancer deaths was drawn from the Pennsylvania death registry, and 433 family members or close friends were interviewed concerning unmet needs during the last month of life. It was estimated that 72% of persons who died of cancer in Pennsylvania experienced at least one unmet service need during this period. The most frequently reported was help with activities of daily living, estimated at 42% of cancer deaths, involving over 11,000 persons each year in the state. There were significantly more unmet needs during the terminal period, compared with just after diagnosis, in activities of daily living, obtaining health care, transportation, and problems with medical staff. Our findings indicate a need to increase a broad range of support programs during the terminal period, especially of home-care services.

Health care policy and regional epidemiology: international comparisons and a case-study from The Netherlands

In a number of countries, regional levels of administration have assumed responsibilities for the health care sector. This paper presents a specification of epidemiological information that could be relevant for health care policy towards and within regions, as well as a review of British and Scandinavian attempts at using routinely available mortality data for these purposes. A Dutch case study is then presented. To determine whether regional mortality data by cause of death can be used as indicators of need for health care, and consequently be used as criteria for the allocation of financial resources, the correspondence between provincial disease-specific mortality, hospital admissions and new cases of disability benefits was analyzed. the findings were not convincing: for a number of diseases a reasonable correspondence between mortality and hospital admissions could be shown; for other conditions, however, especially ischaemic heart disease, none at all. It is concluded that: in the context of the formal allocation of health care resources to administrative units, a strong confidence in mortality data by cause of death is unwarranted; in the (broader) context of developing and evaluating regional health care policy, mortality data by cause of death can be useful for providing a focus on population health status and a starting point for further studies.

An empirical approach to setting priorities within a department of rehabilitation

The current need to maintain or increase levels of service, despite shrinking budgets, has prompted hospital department heads to focus increased attention on their process of decisionmaking around resource allocation. This paper presents a rational method of decision-making through priority-setting. The method was developed in x department of rehabilitation to assist with the cost-effective assignment of staff to the various services in the hospital. The method is based on a set of seventeen weighted criteria, which evaluate the relative importance of services that the department staffs. While the method has specific reference to a rehabilitation department, the authors feel that it may have application to a variety of other departments or settings.