Tuesday, June 12, 2012

[EQ] Priority-Setting in Health: Building Institutions for Smarter Public Spending

Priority-Setting in Health:
Building Institutions for Smarter Public Spending

A report of the Center for Global Development’s Priority-Setting Institutions for Global Health Working Group

Amanda Glassman and Kalipso Chalkidou, Co-chairs – 2012

Available online PDF [101p.] at: http://bit.ly/LYHE9Z

“…….Health donors, policymakers, and practitioners continuously make life-and-death decisions about which type of patients receive what interventions, when, and at what cost. These decisions—as consequential as they are—often result from ad hoc, nontransparent processes driven more by inertia and interest groups than by science, ethics, and the public interest. The result is perverse priorities, wasted money, and needless death and illness.


Examples abound: In India, only 44 percent of children 1 to 2 years old are fully vaccinated, yet open-heart surgery is subsidized in national public hospitals. In Colombia, 58 percent of children are fully vaccinated, but public monies subsidize treating breast cancer with Avastin, a brand-name medicine considered ineffective and unsafe for this purpose in the United States.


Reallocating a portion of public and donor monies toward the most cost-effective health interventions would save more lives and promote health equity. The obstacle is not a lack of knowledge about what interventions are best, but rather that too many low- and middle-income countries lack the fair processes and institutions needed to bring that knowledge to bear on funding decisions.


With that in mind, the Center for Global Development’s Priority-Setting Institutions for Global Health Working Group recommends creating and developing fair and evidence-based national and global systems to more rationally set priorities for public spending on health. The group calls for an interim secretariat to incubate a global health technology assessment facility designed to help governments develop national systems and donors get greater value for money in their grants…”



Executive summary

Chapter 1 Finite resources, unlimited demand

A framework of de facto rationing mechanisms

The timing of rationing: ex ante and ex post

The rationing implications of allocation between areas and within levels of the health system

In a practical sense, however, priority is often revealed by action and spending

Rationing is constrained by historical and political processes

Why the Priority-Setting Institutions in Health Working Group?

Chapter 2 The opportunity: evidence, economies, and donor agendas converge to make explicit rationing necessary and possible

Force 1: A growing body of evidence suggests huge health gains are possible

Force 2: Public spending on health is growing in low- and middle-income countries

Force 3: Donors are beginning to restrict health aid flows, putting renewed emphasis on impact, co-financing, and value for money

Chapter 3 Considering cost-effectiveness: the moral perspective

The cost-effectiveness landscape in global health 1

The moral case

Challenges addressed

Chapter 4 Progress on policy instruments for explicit priority setting

Essential medicines lists

Health benefits plans

National Immunization Technical Advisory Committees

Health technology assessment agencies

Case studies

Chapter 5 Donors and decisions

Development assistance partners’ support to recipient country priority-setting processes

GAVI Alliance prioritization mechanisms

Global Fund prioritization mechanisms

Chapter 6 Building institutions for explicit priority setting

Institutionalizing health technology assessment systems in low- and middle-income countries

Chapter 7 Recommendations for action

Looking ahead

Appendix A – B

Appendix C Current international support to priority setting in low- and middle-income countries

Appendix D Sources for low- and middle-income countries with health benefits plans




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