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Alwan A, Jallah W, Baltussen R, Carballo M, Gonyon E, Gudumac I, Haghparast-Bidgoli H, Jacobs G, Abou Jaoude GJ, Kateh FN, Logan G, Skordis J. Designing an evidence-informed package of essential health services for Universal Health Coverage: lessons learnt and challenges to implementation in Liberia. BMJ Glob Health 2024; 9:e014904. [PMID: 38925666 PMCID: PMC11202745 DOI: 10.1136/bmjgh-2023-014904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/14/2024] [Indexed: 06/28/2024] Open
Abstract
Liberia developed an evidence-informed package of health services for Universal Health Coverage (UHC) based on the Disease Control Priorities 3 evidence. This paper describes the policy decisions, methods and processes adopted for prioritisation, key features of the package and lessons learnt, with special emphasis on feasibility of implementation. Package design was led by the Ministry of Health. Prioritisation of essential services was based on evidence on disease burden, cost-effectiveness, financial risk, equity, budget impact, and feasibility of implementation. Fiscal space analysis was used to assess package affordability and options for expanding the budget envelope. The final adopted package focuses on primary healthcare and comprises a core subpackage of 78 publicly financed interventions and a complementary subpackage of 50 interventions funded through cost-sharing. The estimated per capita cost to the government is US$12.28, averting around 1.2 million DALYs. Key lessons learnt are described: (1) priority setting is essential for designing affordable packages of essential services; (2) the most realistic and affordable option when domestic resources are critically limited is to focus on basic, high-impact primary health services; (3) Liberia and many other countries will continue to rely on donor funding to expand the range of essential services until more domestic resources become available; (4) national leadership and effective engagement of key stakeholders are critical for a successful package design; (5) effective implementation is less likely unless the package cost is affordable and the health system gaps are assessed and addressed. A framework of action was employed to assess the consistency with the prerequisites for an appropriate package design. Based on the framework, Liberia developed a transparent and affordable package for UHC, but the challenges to implementation require further action by the government.
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Affiliation(s)
- Ala Alwan
- Disease Control Priorities 3 (DCP3) Country Translation Project, London School of Hygiene & Tropical Medicine, London, UK
| | - Wilhemina Jallah
- Republic of Liberia Ministry of Health, Monrovia, Montserrado, Liberia
| | - Rob Baltussen
- Department for Health Evidence, Radboudumc, Nijmegen, The Netherlands
| | - Manuel Carballo
- International Centre for Migration, Health and Development, Geneva, Switzerland
| | - Ernest Gonyon
- Republic of Liberia Ministry of Health, Monrovia, Montserrado, Liberia
| | - Ina Gudumac
- Disease Control Priorities 3 (DCP3) Country Translation Project, London School of Hygiene & Tropical Medicine, London, UK
| | | | - George Jacobs
- Republic of Liberia Ministry of Health, Monrovia, Montserrado, Liberia
| | | | - Francis Nah Kateh
- Republic of Liberia Ministry of Health, Monrovia, Montserrado, Liberia
| | - Gorbee Logan
- Republic of Liberia Ministry of Health, Monrovia, Montserrado, Liberia
| | - Jolene Skordis
- Institute for Global Health, University College London, London, UK
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Bidonde J, Lauvrak V, Ananthakrishnan A, Kingkaew P, Peacocke EF. Topic identification, selection, and prioritization for health technology assessment in selected countries: a mixed study design. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:12. [PMID: 38321468 PMCID: PMC10848436 DOI: 10.1186/s12962-024-00513-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/10/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND There is limited evidence-informed guidance on TISP processes for countries where health technology assessment (HTA) is in a nascent phase. We aimed to explore the range of topic identification, selection and prioritization (TISP) processes and practices for HTA in selected countries and identify aspects relevant to emerging HTA systems. METHODS This mixed design study included a systematic literature review, an electronic survey, and individual interviews. We conducted a systematic literature review with criteria that were developed a priori to identify countries deemed to have a recently formalized HTA system. Based on the literature review, a twenty-three item online survey was shared with the identified countries, we completed follow-up interviews with ten participants who have experience with HTA. We analyzed documents, survey responses and interview transcripts thematically to identify lessons related to TISP processes and practices. RESULTS The literature review identified 29 nine candidate countries as having a "potential" recently formalized HTA system. Twenty-one survey responses were analyzed and supplemented with ten individual interviews. We found variation in countries' approaches to TISP - particularly between pharmaceutical and non-pharmaceutical interventions. Results indicate that TISP is heavily driven by policy makers, expert involvement, and to a lesser extent, relevant stakeholders. The use of horizon-scanning and early warning systems is uncommon. Interviewee participants provided further insight to the survey data, reporting that political awareness and an institutional framework were important to support TISP. TISP can be optimized by stronger national regulations and legislative structures, in addition to education and advocacy about HTA among politicians and decision-makers. In some settings regional networks have been useful, particularly in the development of TISP guidelines and methodologies. Additionally, the technical capacity to conduct TISP, and access to relevant local data were factors limiting TISP in national settings. Increased network collaboration and capacity building were reported as future needs. CONCLUSIONS This study provides current insights into a topic where there is limited published peer reviewed literature. TISP is an important first step of HTA, and topics should be selected and prioritized based on local need and relevance. The limited capacity for TISP in settings where HTA is emerging may be supported by local and international collaboration to increase capacity and knowledge. To succeed, both TISP and HTA need to be embedded within national health care priority setting and decision-making. More in-depth understanding of where countries are situtated in formalizing the TISP process may help others to overcome factors that facilitate or hinder progress.
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Affiliation(s)
- Julia Bidonde
- Division of Health Services, Norwegian Institute of Public Health, Skøyen, Postbox 222, 0213, Oslo, Norway
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Canada
| | - Vigdis Lauvrak
- Evidence and Health Technology Assessment, EviHTA, Oslo, Norway
| | - Aparna Ananthakrishnan
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Pritaporn Kingkaew
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Elizabeth F Peacocke
- Division of Health Services, Norwegian Institute of Public Health, Skøyen, Postbox 222, 0213, Oslo, Norway.
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Moradzadeh M, Karamouzian M, Najafizadeh S, Yazdi-Feyzabadi V, Haghdoost AA. International Journal of Health Policy and Management (IJHPM): A Decade of Advancing Knowledge and Influencing Global Health Policy (2013-2023). Int J Health Policy Manag 2023; 12:8124. [PMID: 37579384 PMCID: PMC10425691 DOI: 10.34172/ijhpm.2023.8124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/23/2023] [Indexed: 08/16/2023] Open
Affiliation(s)
- Mina Moradzadeh
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Karamouzian
- Centre On Drug Policy Evaluation, St. Michael’s Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV, Kerman University of Medical Sciences, Kerman, Iran
| | - Sahar Najafizadeh
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Vahid Yazdi-Feyzabadi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali-Akbar Haghdoost
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Khor S, Elsisi ZA, Carlson JJ. How Much Does the US Public Value Equity in Health? A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:418-426. [PMID: 36216706 DOI: 10.1016/j.jval.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/01/2022] [Accepted: 08/22/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES This systematic review aims to summarize and qualitatively assess published evaluations on the US public's preferences for health equity and their willingness to trade-off efficiency for equity. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses literature search extension guidelines, we searched MEDLINE and Embase for relevant peer-reviewed publications on this topic before February 2021. We included English-language articles that solicited US preferences regarding efficiency-equity trade-offs and prioritizing healthcare resources based on socioeconomic status, race, disability, or burden of disease. Quantitative and qualitative data captured were decided a priori and iteratively adapted as themes emerged. RESULTS Fourteen studies were found over a 25-year span. Only 4 focused on resource allocation across social groups. Three distinct notions of fairness were studied: equal distribution of resources, priority to the worse-off, and equal health achieved. We found modest support for equal distribution of resources and willingness to sacrifice efficiency for equity in the United States. Prioritizing the underserved was relatively less studied and received less support and was more preferred when resources were scarce, when allocating resources between social groups, or when participants were informed about the fundamental origins of health inequities. Equal health was the least studied, but received nontrivial support. CONCLUSIONS The existing literature evaluating the US public's understanding and preferences toward equity was severely limited by the lack of rigorous quantitative studies and heterogeneous attribute selection and fairness definitions. High-quality studies that clearly define fairness, focus on social groups, and apply rigorous methods to quantify equity preferences are needed to integrate the public's value on equity into healthcare decisions.
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Affiliation(s)
- Sara Khor
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA, USA.
| | - Zizi A Elsisi
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Josh J Carlson
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA, USA
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Gopinathan U. Evidence-Informed Deliberative Processes for UHC: Progress, Potential and Prudence Comment on "Evidence-Informed Deliberative Processes for Health Benefit Package Design - Part II: A Practical Guide". Int J Health Policy Manag 2023; 12:7541. [PMID: 37579471 PMCID: PMC10125249 DOI: 10.34172/ijhpm.2022.7541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 12/31/2022] [Indexed: 08/16/2023] Open
Abstract
In their recent article on evidence-informed deliberative processes (EDPs) for health benefit package decisions, Oortwijn et al examine how the different steps of EDP play out in eight countries with relatively mature institutions for using health technology assessment (HTA). This commentary examines how EDP addresses stakeholder involvement in decision-making for equitable progress towards universal health coverage (UHC). It focuses on the value of inclusiveness, the need to pay attention to trade-offs between desirable features of EDP and the need to broaden the scope of processes examined beyond those specifically tied to producing and using HTAs . It concludes that EDPs have contributed to significant progress for health benefit design decisions worldwide and holds much potential in further application. At the same time, this commentary calls for prudence: investments in EDPs should be efficiently deployed to enhance the pre-existing legislative, institutional and political framework that exist to promote fair and legitimate healthcare decisions.
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Affiliation(s)
- Unni Gopinathan
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
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Wale JL, Sehmi K, Kamoga R, Ssekubugu R. Civil society and medical product access in Africa: Lessons from COVID-19. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 5:1091425. [PMID: 36824260 PMCID: PMC9941705 DOI: 10.3389/fmedt.2023.1091425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/16/2023] [Indexed: 02/10/2023] Open
Abstract
Understanding health as a human right creates a legal obligation on countries to ensure access to timely, acceptable, and affordable health care. We highlight the importance of a meaningful role for civil society in improving access to well-regulated quality medical products in Africa; to support and be part of a regional social contract approach following the access issues that have been particularly evident during the COVID-19 pandemic. We argue that African communities have a clear participatory role as important stakeholders in the regulatory lifecycle. Solidarity is important for a cohesive approach as formal government healthcare infrastructure may be minimal for some countries, with little training of communities available for disease management and insufficient money to fund people to organise and deliver health care. Some of the issues for civil society engagement with multi-stakeholders, and possible mitigating strategies, are tabulated to initiate discussion on facilitators and concerns of governments and other stakeholders for meaningful participation by patients, communities and civil society within a regional regulatory lifecycle approach. Solidarity is called for to address issues of equity, ethics and morality, stigmatisation and mutual empowerment - to sustainably support the region and national governments to develop greater self-sufficiency throughout the regulatory lifecycle. By creating a participatory space, patients, communities and civil society can be invited in with clear missions and supported by well-defined guidance to create a true sense of solidarity and social cohesion. Strong leadership coupled with the political will to share responsibilities in all aspects of this work is key.
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Affiliation(s)
- Janet L. Wale
- Independent Researcher, Brunswick, VIC, Australia,Correspondence: Janet L. Wale
| | - Kawaldip Sehmi
- International Alliance of Patients' Organisations, London, United Kingdom
| | - Regina Kamoga
- Uganda Alliance of Patients Organizations (UAPO), World Patient Alliance (WPA), CHAIN, Kampala, Uganda
| | - Robert Ssekubugu
- Rakai Health Sciences Program Research Institute in Kalisizo, Kalisizo, Uganda
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Baltussen R, Mwalim O, Blanchet K, Carballo M, Eregata GT, Hailu A, Huda M, Jama M, Johansson KA, Reynolds T, Raza W, Mallender J, Majdzadeh R. Decision-making processes for essential packages of health services: experience from six countries. BMJ Glob Health 2023; 8:bmjgh-2022-010704. [PMID: 36657809 PMCID: PMC9853142 DOI: 10.1136/bmjgh-2022-010704] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/02/2022] [Indexed: 01/20/2023] Open
Abstract
Many countries around the world strive for universal health coverage, and an essential packages of health services (EPHS) is a central policy instrument for countries to achieve this. It defines the coverage of services that are made available, as well as the proportion of the costs that are covered from different financial schemes and who can receive these services. This paper reports on the development of an analytical framework on the decision-making process of EPHS revision, and the review of practices of six countries (Afghanistan, Ethiopia, Pakistan, Somalia, Sudan and Zanzibar-Tanzania).The analytical framework distinguishes the practical organisation, fairness and institutionalisation of decision-making processes. The review shows that countries: (1) largely follow a similar practical stepwise process but differ in their implementation of some steps, such as the choice of decision criteria; (2) promote fairness in their EPHS process by involving a range of stakeholders, which in the case of Zanzibar included patients and community members; (3) are transparent in terms of at least some of the steps of their decision-making process and (4) in terms of institutionalisation, express a high degree of political will for ongoing EPHS revision with almost all countries having a designated governing institute for EPHS revision.We advise countries to organise meaningful stakeholder involvement and foster the transparency of the decision-making process, as these are key to fairness in decision-making. We also recommend countries to take steps towards the institutionalisation of their EPHS revision process.
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Affiliation(s)
- Rob Baltussen
- Department of Health Evidence, Radboudumc, Nijmegen, The Netherlands
| | - Omar Mwalim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Karl Blanchet
- Global Health Development, University of Geneva Faculty of Medicine, Geneve, Switzerland
| | - Manuel Carballo
- International Centre for Migration and Health, Geneva, Switzerland
| | - Getachew Teshome Eregata
- Department of Global Public Health and Primary care, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
| | - Alemayehu Hailu
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway,Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Maryam Huda
- Department of Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - Mohamed Jama
- Federal Government of Somalia, Mogadishu, Somalia
| | - Kjell Arne Johansson
- Department of Global Public Health and Primary care, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
| | - Teri Reynolds
- Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Wajeeha Raza
- Centre for Health Economics, University of York, York, UK
| | | | - Reza Majdzadeh
- School of Health and Social Care, University of Essex, Colchester, UK
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DiStefano MJ. Moral and Social Values in Evidence-Informed Deliberative Processes for Health Benefit Package Design Comment on "Evidence-Informed Deliberative Processes for Health Benefit Package Design - Part II: A Practical Guide". Int J Health Policy Manag 2022; 12:7480. [PMID: 37579447 PMCID: PMC10125053 DOI: 10.34172/ijhpm.2022.7480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 11/27/2022] [Indexed: 08/16/2023] Open
Abstract
An evidence-informed deliberative process (EDP) is defined as "a practical and stepwise approach for health technology assessment (HTA) bodies to enhance legitimate health benefit package design based on deliberation between stakeholders to identify, reflect and learn about the meaning and importance of values, informed by evidence on these values." In this commentary, I discuss some considerations for EDPs that arise from acknowledging the difference between social and moral values. First, the best practices for implementing EDPs may differ depending on whether the approach is grounded in moral versus social values. Second, the goals of deliberation may differ when focused on moral versus social values. I conclude by offering some considerations for future research to support the use of EDPs in practice, including the need to assess how different approaches to appraisal (eg, more quantitative versus qualitative) impact perceptions of the value of deliberation itself.
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Affiliation(s)
- Michael J. DiStefano
- Department of Health Policy & Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
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Sajadi HS, Jama M, Majdzadeh R. Institutionalisation Is a Vital Element for Fairness of Priority Setting in the Package Design if the Target is Universal Health Coverage Comment on "Evidence-Informed Deliberative Processes for Health Benefits Package Design - Part II: A Practical Guide". Int J Health Policy Manag 2022; 12:7544. [PMID: 37579458 PMCID: PMC10125206 DOI: 10.34172/ijhpm.2022.7544] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 11/12/2022] [Indexed: 08/16/2023] Open
Abstract
The evidence-informed deliberative processes (EDPs) guide provides a practical framework for fair priority setting of the health benefits package (HBP) that countries can reasonably use. The steps presented in the EDPs are applicable for prioritising health services in designing HBP and are consistent with practical experience in countries. However, institutionalisation must be considered an element of fairness in the priority-setting process if the aim is to reach broader goals of a health system, such as universal health coverage (UHC). Otherwise, the EDPs for priority setting might not be integrated into the formal health system or impactful, resulting in a waste of time and resources, which is unfair. Institutionalisation means formalising the desired change as an embedded and integrated system so that the change lasts over time. For the institutionalisation of EPDs, four stages are suggested, which are (1) establishing a supportive legal framework, (2) designating governance and institutional structure, (3) stipulating the EDPs processes and (4) individual and institutional capacity building.
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Affiliation(s)
- Haniye Sadat Sajadi
- Knowledge Utilization Research Center, University Research and Development Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohamed Jama
- Ministry of Health, Federal Government of Somalia, Mogadishu, Somalia
| | - Reza Majdzadeh
- Interdisciplinary Research and Practice Division, School of Health and Social Care, University of Essex, Colchester, UK
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Nouhi M, Baltussen R, Razavi SS, Bijlmakers L, Sahraian MA, Goudarzi Z, Farokhian P, Khedmati J, Jahangiri R, Olyaeemanesh A. The Use of Evidence-Informed Deliberative Processes for Health Insurance Benefit Package Revision in Iran. Int J Health Policy Manag 2022; 11:2719-2726. [PMID: 35247943 PMCID: PMC9818091 DOI: 10.34172/ijhpm.2022.6485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 02/09/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Iran considers the revision of its health insurance benefit package (HIBP) as a means to achieve universal health coverage (UHC). Yet, its decision-making process has been criticised for being weak in terms of accountability and transparency. This paper reports on the development and implementation of the HIBP revision in Iran in the period 2019-2021, employing evidence-informed deliberative processes (EDPs), a framework for benefit package design with the explicit aim of optimising the legitimacy of decision-making. METHODS The High Council for Health Insurance (HCHI) is coordinating the HIBP revision: it planned the six steps of the EDP framework with support from World Health Organization (WHO) and Radboudumc in 2019, and conducted a pilot project on multiple sclerosis (MS) diagnosis and treatment in 2020. RESULTS Implementation of the MS pilot project concerned the installation of advisory committees (involving some 60 stakeholders in supportive task forces, a technical working group [TWG] and a national advisory committee [NAC]), the selection of decision criteria (relating to quality of care, necessity, and sustainability), the inclusion of services for evaluation (nine in total), and the assessment and appraisal of these services. CONCLUSION Implementation of the priority setting process for MS diagnosis and treatment services has likely improved the legitimacy of decision-making by involving stakeholders who engaged in deliberation based on available evidence in a stepwise, transparent process. It is expected to improve the quality of care for MS patients as well as its financial accessibility, at a zero net budget impact. The pilot project has served to help Iran's health system move faster toward UHC for a broader range of essential health services.
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Affiliation(s)
- Mojtaba Nouhi
- National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Rob Baltussen
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Seyed Sajad Razavi
- Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leon Bijlmakers
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Moahmmad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Goudarzi
- Health Human Resources Research Center, Department of Health Economics, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parisa Farokhian
- High Council for Health Insurance, Ministry of Health and Medical Education, Tehran, Iran
| | - Jamaleddin Khedmati
- Pharmaceutical Management and Economics Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Jahangiri
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Olyaeemanesh
- Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Baltussen R, Jansen M, Oortwijn W. Evidence-Informed Deliberative Processes for Legitimate Health Benefit Package Design - Part I: Conceptual Framework. Int J Health Policy Manag 2022; 11:2319-2326. [PMID: 34923808 PMCID: PMC9808261 DOI: 10.34172/ijhpm.2021.158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 11/09/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Countries around the world are increasingly rethinking the design of their health benefit packages to achieve universal health coverage (UHC). Health technology assessment (HTA) bodies support governments in these decisions, but employ value frameworks that do not sufficiently account for the intrinsically complex and value-laden political reality of benefit package design. METHODS Several years ago, evidence-informed deliberative processes (EDPs) were developed to address this issue. An EDP is a practical and stepwise approach for HTA bodies to enhance legitimate health benefit package design based on deliberation between stakeholders to identify, reflect and learn about the meaning and importance of values, and to interpret available evidence on these values. We further developed the conceptual framework and initial 2019 guidance based on academic knowledge exchange, analysing practices of HTA bodies, surveying HTA bodies and experts around the globe, and implementation of EDPs in several countries around the world. RESULTS EDPs stem from the general concept of legitimacy, which is translated into four elements - stakeholder involvement ideally operationalised through stakeholder participation with deliberation; evidence-informed evaluation; transparency; and appeal. The 2021 practical guidance distinguishes six practical steps of a HTA process and provides recommendations on how these elements can be implemented in each of these steps. CONCLUSION There is an increased attention for legitimacy, deliberative processes for HTA and health benefit package design, but the development of theories and methods for such processes remain behind. The added value of EDPs lies in the operationalisation of the general concept of legitimacy into practical guidance for HTA bodies.
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Affiliation(s)
- Rob Baltussen
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Bijlmakers L. Systems Science and Evidence-Informed Deliberation to Mitigate Dilemmas in Situations of Dual Agency at the Hospital Level Comment on "Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations". Int J Health Policy Manag 2022; 11:2337-2339. [PMID: 35247940 PMCID: PMC9808293 DOI: 10.34172/ijhpm.2022.6940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 02/12/2022] [Indexed: 01/12/2023] Open
Abstract
The article by Waitzberg et al on dual agency in hospitals reports on three strategies to mitigate dilemmas arising from conflicting clinical and economic considerations. This could be further explored by using systems science methods that allow in-depth analyses of (health) system dynamics, networks, and agent-based modelling, and that take into account local context, incentives and how institutions work. Future studies may also draw on the literature of multi-criteria decision-making and evidence-informed deliberative processes (EDPs) that are increasingly being used to optimise legitimate health benefit package design. Toolkits to assist hospital professionals in improving their decision-making need to be practical, with ample attention for the process of decision-making, including transparency, use of evidence, and opportunities for health professionals (and possibly others stakeholders) to contest or formally appeal against certain decisions.
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Affiliation(s)
- Leon Bijlmakers
- Department for Health Evidence (HEV), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
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Guzman J. Three Approaches to Improve a Practical Guide on Evidence-Informed Deliberative Processes for Health Benefit Package Design Comment on "Evidence-Informed Deliberative Processes for Health Benefit Package Design - Part II: A Practical Guide". Int J Health Policy Manag 2022; 12:7502. [PMID: 36086853 PMCID: PMC10125080 DOI: 10.34172/ijhpm.2022.7502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/13/2022] [Indexed: 11/09/2022] Open
Abstract
As countries around the world seek to deliver universal health coverage, they must prioritize which services to pay for with public funds, to whom, and at what cost. Countries are increasingly using health technology assessment (HTA) to identify which interventions provide the best value for money and merit inclusion in their health benefit packages (HBPs)-the explicit lists of health services provided using public funds. Oortwijn et al understand the importance of providing practical guidance on the foundation of HBP design, and their article, "Evidence-Informed Deliberative Processes for Health Benefit Package Design - Part II: A Practical Guide," provides recommendations for HTA bodies to improve the legitimacy of their decision-making by incorporating four elements in their HBP procedures: stakeholder involvement, evidence-informed evaluation, transparency, and appeal. This article proposes three approaches to enhance the value of the guide: moving from structure to compliance and performance, prioritizing key issues of legitimacy within HBP processes, and acknowledging potential the costs and risks associated with the use of this framework.
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Bond K. Challenges and Opportunities for Deliberative Processes for Healthcare Decision-Making Comment on "Evidence-Informed Deliberative Processes for Health Benefit Package Design - Part II: A Practical Guide". Int J Health Policy Manag 2022; 12:7458. [PMID: 35988028 PMCID: PMC10125176 DOI: 10.34172/ijhpm.2022.7458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 07/31/2022] [Indexed: 11/09/2022] Open
Abstract
The second edition of the practical guide for evidence-informed deliberative processes (EDPs) is an important addition to the growing guidance on deliberative processes supporting priority setting in healthcare. While the practical guide draws on an extensive amount of information collected on established and developing processes within a range of countries, EDPs present health technology assessment (HTA) bodies with several challenges. (1) Basing recommendations on current processes that have not been well-evaluated and that have changed over time may lead to weaker legitimacy than desired. (2) The requirement for social learning among stakeholders may require increased resourcing and blur the boundary between moral deliberation and political negotiation. (3) Robust evaluation should be based on an explicit theory of change, and some process outcomes may be poor guides to overall improvement of EDPs. This comment clarifies and reinforces the recommendations provided in the practical guide.
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Affiliation(s)
- Kenneth Bond
- Institute of Health Economics, Edmonton, AB, Canada
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Culyer AJ. Reinforcing Science and Policy, With Suggestions for Future Research Comment on "Evidence-Informed Deliberative Processes for Health Benefit Package Design - Part II: A Practical Guide". Int J Health Policy Manag 2022; 12:7398. [PMID: 35942975 PMCID: PMC10125096 DOI: 10.34172/ijhpm.2022.7398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/29/2022] [Indexed: 11/09/2022] Open
Abstract
Oortwijn et al continue their guide to good practice in the use of deliberative processes in health technology assessment (HTA) based on a survey of international practice. This is useful, and I applaud their care in maintaining objectivity, especially regarding the treatment of moral and politically controversial issues, in reporting how jurisdictions have handled such matters in designing HTA procedures and in their execution. To their suggestions for future research, I add: the historical development of deliberation in healthcare decision-making and in other fields of public choice, with comparisons of methods, successes and failures; development of guidance on the design and use of deliberative processes that enhance decision-making when there is no consensus amongst the decision-makers; ways of identifying and managing context-free and context-sensitive evidence; and a review of high-level capacity building to raise awareness of HTA and the use of knowledge translation and exchange (KTE) and deliberation amongst policy makers, especially in low and middle-income countries.
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Affiliation(s)
- Anthony J. Culyer
- Department of Economics and Related Studies and Centre for Health Economics, University of York, York, UK
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