Health Equity: 02/11/09

Wednesday, February 11, 2009

[EQ] Engaging the Public in Health Care Policy: Why do it? and What are the Challenges?

PUBLIC ENGAGEMENT (PART I)
ENGAGING THE PUBLIC IN HEALTHCARE POLICY: WHY DO IT? AND WHAT ARE THE CHALLENGES?

InsightandAction Issue 48, February 2009

Canadian Health Services Research Foundation

Available online at: http://www.chsrf.ca/other_documents/insight_action/html/documents/Insight_and_Action_48_e_000.pdf

“….The development of evidence-informed healthcare policies relies heavily on the hierarchies of research and the technical know-how of experts. However, the experiences, opinions, and value preferences of patients, the general public and consumer advocates also play a legitimate and useful role, especially when difficult, value-laden decisions must be made.

KEY MESSAGES

- The opinions and perspectives of the public play a valuable role in developing high-quality, evidence-informed policy guidance.

- Engaging the public in health policy decisions can increase the public’s trust and confidence in their healthcare system.

- The public holds important health knowledge, but this knowledge should be applied carefully and appropriately,
in line with the context and purpose of the decision in question….”

PUBLIC ENGAGEMENT (PART II):*
HOW DO DELIBERATIVE PROCESSES ACHIEVE MEANINGFUL PUBLIC ENGAGEMENT?

InsightandAction Issue 49, February 2009

Canadian Health Services Research Foundation

Available online at: http://www.chsrf.ca/other_documents/insight_action/html/documents/Insight_and_Action_49_e.pdf

‘….A number of methods can be used to engage members of the public, including surveys, interviews, focus groups, requests for submissions, open houses, and public meetings. Each has its own strengths and weaknesses.i Another approach that is becoming increasingly accepted is the use of the deliberative process, which is broadly defined as “a tool for producing guidance based on heterogeneous evidence,” ii More specifically, the deliberative approach is a collective problem-solving process that involves gathering information from a wide variety of sources, with a view to making informed decisions or recommendations on a specific issue. Deliberative processes are thought to be well-suited for soliciting perspectives on a wide range of issues, including healthcare.

KEY MESSAGES

- Deliberative processes are often relied upon to capture the diverse perspectives of members of the general public, patients,
and others on a wide range of healthcare topics.

- Using deliberative processes encourages informed public dialogue and leads to policy recommendations that incorporate various points of view.

- Deliberative processes that focus on concrete recommendations are more likely to have a direct influence on healthcare decision-making. …”

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues. [DD/ KMC Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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[EQ] Consultation process for the System of Health Accounts

Consultation process for the System of Health Accounts (SHA) Manual 2.0

WHO website: http://www.who.int/nha/methods/en/index.html

“….Given the importance of global standards for health accounting, OECD, EUROSTAT and WHO have agreed to collaborate on the further development of methodologies for health accounts, culminating in the revision of the System of Health Accounts (SHA) manual. The purpose of the revision is to make the methodology suitable to be the global standard accounting framework for statistics on health expenditure and financing.

OECD, Eurostat and WHO all have in their work programme the revision of the health accounts methodology and a draft of the SHA Manual Version 2.0 by the end of 2009.

OECD Website: http://www.oecd.org/health/sha/revision

What is the System of Health Accounts?
Over recent decades, there has been a growing need of health policy analysts to address such questions as:

What are the main drivers accounting for health expenditure growth?

What factors explain the observed differences between countries?

What are the main structural differences in health spending between countries?

How are changes in the structure of health spending and performance of health systems related?

To answer those questions, a common international system of statistical reporting rules was needed.
The System of Health Accounts (SHA) establishes a set of common concepts, definitions, classifications
and accounting rules to enable comparability of health spending data over time and across countries.
The System of Health Accounts (SHA) addresses three basic questions:

Where does the money come from?

Where does the money go to?

What kind of services are performed and what types of goods are purchased?

Why revise? There are unresolved issues in SHA methodology. These include:

a lack of adequate methods for output and price measurement;

the definition of the boundary between health and long-term care; and

the boundary of public health.

The revised SHA Manual aims to provide a refined conceptual framework and a revised and expanded version
of the International Classification for Health Accounts in order to:

improve the comparability of health expenditure data across countries and over time;

provide better information for assessing the performance of health systems; and

provide better information on the role of the health sector within the national economy.

Progress: http://www.oecd.org/document/15/0,3343,en_40045874_40037563_41680143_1_1_1_1,00.html

FRAMEWORK FOR THE CONSULTATION PROCESS RELATED TO THE REVISION OF
THE SYSTEM OF HEALTH ACCOUNTS (SHA)

PDF: http://www.oecd.org/dataoecd/46/53/40439697.pdf

The revision of the System of Health Accounts (SHA) requires an agreed programme of work and a framework for co-operation between OECD, Eurostat and WHO and a wider consultation process involving other international and national organisations, networks and individual experts engaged in producing and utilising national health accounts. Three documents, including this one, are being prepared to guide the revision process.

These documents are:

1. Terms of reference for the International Health Accounts Team (IHAT),

2. Framework for the consultation process related to revising the SHA,

3. Programme of Work for the SHA revision.

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PAHO/WHO Website: http://66.101.212.219/equity/

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[EQ] General budget support in developing countries: ensuring the health sector's interest

General budget support in developing countries: ensuring the health sector's interest

Adélio Fernandes Antunes, Guy Carrin and David B. Evans

Department of Health Systems Financing - Health Financing Policy

World Health Organization 2008

Available online PDF [11p.] at: http://www.who.int/health_financing/documents/pb_e_08_2-budget_support.pdf

“……Budget support refers to aid where
(i) funds are channelled through the national treasury; and
(ii) the allocation and management of these funds respects national priorities and procedures.

Budget support targets results delivery in a longer-term horizon than projects. Over the past decade, it has been accompanied by a focus on the importance of good governance to create capacities for sustainable development. In contrast to projects, it concentrates on outcomes rather than outputs, and emphasizes the importance of ownership of policies and programmes by recipient countries. Policy-dialogue between donors and recipient countries is supposed to build on and reinforce partnership. Budget support programmes can take various forms and designs, although two main categories can be identified: GBS and Sector Budget Support (SBS)….”

“…..General budget support GBS is playing an increasing role in today's aid environment. Ministries of health need to understand how it works, and how to influence decisions about the allocation of the resources it brings - as they should do for all aid instruments.

Active, early participation in poverty reduction strategy discussions and subsequent General budget support GBS negotiations will increase their ability to negotiate adequate funding. It will also ensure that any reforms initiated as part of conditions agreed in GBS programmes are realistic and non-damaging for the health sector. To play this role, ministries of health may need to develop their skills in public administration, financial management and policy-dialogue. It will also require that they properly address good governance issues within the health sector….”

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PAHO/WHO Website: http://66.101.212.219/equity/

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