Political motivation as a key driver for universal health coverage

Variation in public investments to health, health outcomes, and progress toward universal health coverage across countries is vast and neither economic status nor the knowledge on solutions have borne out to be binding constraints to health improvements. The drivers for universal health coverage go beyond the macro-economic context of a nation, and as pointed out by scholars, are deeply linked with the extent of political prioritization of healthcare. Low public investments to health in India and slow movement toward universal health coverage underline the need for more attention to the political priority accorded to health in the country. While the role of politics in policy reforms has been established by several scholars, this paper seeks to identify the intrinsic motivations or incentives that drive political priority. Drawing on the experience of nine countries, the paper attempts to inform the analysis for countries such as India (where progress toward universal health coverage remains slow), on the political incentives for prioritization of healthcare, and how these may be shaped or strengthened. The analysis finds that health care reforms happen in (at least) two stages: the existence and recognition of a national context and a problem, followed by political opportunities and motivations which lead political leaders to address the identified problem. The paper separates motivation as a distinct factor for analysis because, in the absence of strong incentives, not every political opportunity may lead to attention to an issue, and finds that reforms were motivated by a need to gain political legitimacy by an incoming regime, or by its political ideology, or a combination of both. Importantly, political motivation does not always take root in itself, but often driven by external factors and stakeholders who contribute to creating or strengthening incentives for political attention. A greater role from citizens and other actors such as elected representatives, questioning status quo and highlighting the schisms in the social contract between a political regime and citizens may contribute to shifting the source of legitimacy for leaders.

Can We Incorporate Societal Values in Resource Allocation Decisions Among Disease Categories? An Empirical Approach

OBJECTIVES

Historically, resource allocation decisions in healthcare are based on univariate approaches, inevitably overlooking value dimensions that are essential from a societal welfare maximization perspective. This article aims to present a wider perspective on decision making that incorporates societal values when prioritizing future resource allocation among disease areas.

METHODS

Sociotechnical application of multiple-criteria decision analysis with a set of criteria (value judgments) that are based on positive as well as normative dimensions of resource allocation. We use Greece as a case study. Societal value judgments were sourced via a multidisciplinary panel of experts who collectively provided criteria weights and scores for each alternative (16 disease categories, classified according to the Global Burden of Disease study) against each criterion. An additive value function provided the total value in priority preference for each alternative.

RESULTS

The criteria that were deemed relevant to the decision-making process and their respective relative weights were burden of disease (0.245), capacity to benefit (0.190), direct cost and projected changes in the next 5 years (0.160), indirect cost (0.132), intensity of unmet needs (0.109), incidence of catastrophic expenditure (0.091), and caring externalities (0.073). The additive value function revealed that the top 5 priorities in highest total value scores were neoplasms, circulatory diseases, injuries, neurologic diseases, and musculoskeletal diseases.

CONCLUSIONS

Incorporation of societal value criteria in resource allocation decisions can highlight priorities and lead to different sets of planning decisions than solely demand-driven allocation.