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Heenan M, Jan S, Ralph M, Sacks G, Swinburn B, Shanthosh J. Priority setting for non-communicable disease prevention - Co-producing a regulatory agenda informing novel codes of practice in Australia. Soc Sci Med 2023; 333:116149. [PMID: 37573676 DOI: 10.1016/j.socscimed.2023.116149] [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: 08/21/2022] [Revised: 04/29/2023] [Accepted: 08/04/2023] [Indexed: 08/15/2023]
Abstract
There are a range of priority setting methods for non-communicable disease (NCDs) prevention. However, existing methods are often designed without detailed consideration of local context and political economy- critical success factors for implementation. In Australia, codes of practice under state government Public Health Acts could be used for NCD prevention. To inform the potential development of codes of practice under Public Health Acts, this study aimed to co-create a priority setting framework that accounts for local context and the prevailing regulatory agenda. A priority setting framework was co-produced by a multidisciplinary technical advisory group consisting of government representatives, public health lawyers and academic experts. It incorporated general prioritisation criteria (evidence, cost-effectiveness, equity, burden of disease) and local contextual criteria (legal compatibility, unmet-needs, political acceptability, structural and technical feasibility, community support). The framework was then applied in practice through surveys and policy dialogue workshops to discuss political economy factors. Policies were limited to nutrition, alcohol and physical activity risk factors. Through the prioritisation process, the most impactful, feasible and acceptable policies for NCD prevention via state government codes of practice were: restrictions on in-store placement of unhealthy products, enhancing data systems and capabilities for health surveillance and implementation monitoring, removal of unhealthy foods and drinks sold and supplied in public institutions, prohibition of marketing of unhealthy foods and drinks on assets controlled by government, and implementation of subsidies or grants to increase fruit and vegetable intake. The process illustrated that explicit consideration of local context, legal compatibility and the political economy had a substantial influence on the prioritised list of actions. The proposed priority setting framework is designed to be flexible and adaptable to varying contexts, can be embedded in government processes or utilised by researchers and practitioners to co-produce a regulatory agenda that is locally relevant.
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Affiliation(s)
- Maddie Heenan
- The George Institute for Global Health, University of New South Wales, Level 5/ 1 King St, Newtown, NSW, 2042, Australia; Australian Human Rights Institute, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Level 5/ 1 King St, Newtown, NSW, 2042, Australia.
| | - Martyn Ralph
- The George Institute for Global Health, University of New South Wales, Level 5/ 1 King St, Newtown, NSW, 2042, Australia.
| | - Gary Sacks
- Global Obesity Centre, Deakin University, Melbourne Burwood Campus, Burwood, VIC, 3125, Australia.
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Auckland, 1010, New Zealand.
| | - Janani Shanthosh
- The George Institute for Global Health, University of New South Wales, Level 5/ 1 King St, Newtown, NSW, 2042, Australia; Australian Human Rights Institute, University of New South Wales, Sydney, NSW, 2052, Australia.
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Campbell JA, Ezzy D, Neil A, Hensher M, Venn A, Sharman MJ, Palmer AJ. A qualitative investigation of the health economic impacts of bariatric surgery for obesity and implications for improved practice in health economics. HEALTH ECONOMICS 2018; 27:1300-1318. [PMID: 29855095 DOI: 10.1002/hec.3776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/19/2017] [Accepted: 03/06/2018] [Indexed: 06/08/2023]
Abstract
Obesity is an economic problem. Bariatric surgery is cost-effective for severe and resistant obesity. Most economic evaluations of bariatric surgery use administrative data and narrowly defined direct medical costs in their quantitative analyses. Demand far outstrips supply for bariatric surgery. Further allocation of health care resources to bariatric surgery (particularly public) could be stimulated by new health economic evidence that supports the provision of bariatric surgery. We postulated that qualitative research methods would elicit important health economic dimensions of bariatric surgery that would typically be omitted from the current economic evaluation framework, nor be reported and therefore not considered by policymakers with sufficient priority. We listened to patients: Focus group data were analysed thematically with software assistance. Key themes were identified inductively through a dialogue between the qualitative data and pre-existing economic theory (perspective, externalities, and emotional capital). We identified the concept of emotional capital where participants described life-changing desires to be productive and participate in their communities postoperatively. After self-funding bariatric surgery, some participants experienced financial distress. We recommend a mixed-methods approach to the economic evaluation of bariatric surgery. This could be operationalised in health economic model conceptualisation and construction, through to the separate reporting of qualitative results to supplement quantitative results.
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Affiliation(s)
- Julie A Campbell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Douglas Ezzy
- School of Sociology, Faculty of Arts, University of Tasmania, Sandy Bay, Tasmania, Australia
| | - Amanda Neil
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Martin Hensher
- Department of Health and Human Services, Hobart, Tasmania, Australia
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Melanie J Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Camilo Fuentes J, Andrea Cañón L, Viviana Pérez Á, E Pinzón C, María Pérez A, Avellaneda PA, Enrique Morales Á, Enrique Fernández YJ. Metodologías para la priorización en investigación en salud: una revisión sistemática de la literatura. Rev Panam Salud Publica 2017; 41:e122. [PMID: 31384258 PMCID: PMC6645202 DOI: 10.26633/rpsp.2017.122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 12/17/2017] [Indexed: 11/24/2022] Open
Abstract
Objetivo. Identificar elementos metodológicos clave para la priorización en investigación en salud, a partir de las metodologías reportadas en la literatura científica. Métodos. Se realizó una búsqueda sistemática en Medline, Embase, LILACS, y fuentes complementarias de literatura gris. Se utilizaron las palabras clave: research, methods y health priorities, en combinación con términos libres. Dos revisores independientes, de acuerdo con criterios previamente definidos, seleccionaron revisiones de la literatura o documentos metodológicos que presentaran metodologías para priorización en investigación en salud. Se extrajeron las principales características de las metodologías reportadas y se identificaron elementos comunes. Resultados. Se incluyeron siete revisiones y cinco documentos metodológicos, que reportaron cuatro metodologías estructuradas específicas y múltiples aproximaciones metodológicas que combinan elementos diversos. En general, estas metodologías integran la perspectiva de actores clave con información objetiva, mediante la aplicación de técnicas estandarizadas de participación, para establecer un ranking de prioridades, con base en criterios previamente definidos. Se identificaron elementos metodológicos comunes relacionados con pasos del proceso, mecanismos de participación, criterios para priorizar y análisis de resultados. Conclusión. La priorización en investigación en salud requiere el empleo de una metodología definida a priori, que debe contener como mínimo cuatro elementos clave: pasos claros del proceso, criterios para priorizar, técnicas formales de participación y métodos de análisis de resultados. Estos elementos deben ajustarse a las condiciones y necesidades del contexto de aplicación.
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Affiliation(s)
- Juan Camilo Fuentes
- Instituto de Evaluación Tecnológica en Salud Instituto de Evaluación Tecnológica en Salud Bogotá Colombia Instituto de Evaluación Tecnológica en Salud, Bogotá, Colombia
| | - Lorena Andrea Cañón
- Instituto de Evaluación Tecnológica en Salud Instituto de Evaluación Tecnológica en Salud Bogotá Colombia Instituto de Evaluación Tecnológica en Salud, Bogotá, Colombia
| | - Ángela Viviana Pérez
- Instituto de Evaluación Tecnológica en Salud Instituto de Evaluación Tecnológica en Salud Bogotá Colombia Instituto de Evaluación Tecnológica en Salud, Bogotá, Colombia
| | - Carlos E Pinzón
- Instituto de Evaluación Tecnológica en Salud Instituto de Evaluación Tecnológica en Salud Bogotá Colombia Instituto de Evaluación Tecnológica en Salud, Bogotá, Colombia
| | - Angélica María Pérez
- Instituto Nacional de Salud Instituto Nacional de Salud Bogotá Colombia Instituto Nacional de Salud, Bogotá, Colombia
| | - Paola Astrid Avellaneda
- Instituto de Evaluación Tecnológica en Salud Instituto de Evaluación Tecnológica en Salud Bogotá Colombia Instituto de Evaluación Tecnológica en Salud, Bogotá, Colombia
| | - Álvaro Enrique Morales
- Instituto Nacional de Salud Instituto Nacional de Salud Bogotá Colombia Instituto Nacional de Salud, Bogotá, Colombia
| | - Y Jorge Enrique Fernández
- Ministerio del Trabajo Ministerio del Trabajo Bogotá Colombia Ministerio del Trabajo, Bogotá, Colombia
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Angell B, Pares J, Mooney G. Implementing priority setting frameworks: Insights from leading researchers. Health Policy 2016; 120:1389-1394. [PMID: 27839887 DOI: 10.1016/j.healthpol.2016.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 10/01/2016] [Accepted: 10/06/2016] [Indexed: 10/20/2022]
Abstract
In spite of a substantial literature developing frameworks for policymakers to use in resource allocation decisions in healthcare, there remains limited published work reporting on the implementation or evaluation of such frameworks in practice. This paper presents findings of a targeted survey of 18 leading researchers around the implementation and evaluation of priority-setting exercises. Approximately one third of respondents knew of situations where recommendations of priority-setting exercises had been implemented, one third knew that recommendations had not been implemented and the final third responded that they did not know whether recommendations had been adopted. The lack of evidence linking the implementation of priority-setting recommendations to equity and efficiency outcomes was highlighted by all respondents. Features identified as facilitating successful implementation of priority-setting recommendations included having a climate ready to accept priority-setting, good leadership or a 'champion' for the priority-setting process and having a health economist to guide the process. Successful disinvestment was very uncommon in the experience of the researchers surveyed. Recommendations emerging from Program Budgeting and Marginal Analysis exercises appeared to be more widely implemented than those coming from alternative processes. Identifying if the process was repeated following the initial process was suggested as a means to measure success.
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Affiliation(s)
- Blake Angell
- NSW Agency for Clinical Innovation, Level 4, Sage Building, 67 Albert Avenue, Chatswood, NSW 2057, Australia; The George Institute for Global Health, Sydney Medical School, King George V Building 83 Missenden Road Camperdown 2050, Australia.
| | - Jennie Pares
- NSW Agency for Clinical Innovation, Level 4, Sage Building, 67 Albert Avenue, Chatswood, NSW 2057, Australia
| | - Gavin Mooney
- Sydney School of Public Health, Edward Ford Building (A27), Fisher Road, University of Sydney, NSW 2006, Australia
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Abstract
Purpose - The purpose of this paper is to explore the experiences of staff in a large, public health service involved in transitioning support services to a shared services model. It aims to understand their perceptions of the benefits and risks arising from this change. Design/methodology/approach - Thematic analysis of qualitative data from semi-structured interviews with both service provider and customer agency staff was used to identify, analyze and report patterns of benefits and risks within data. Findings - Staff expressed the need for relevant subject-matter-experts to work within customer agencies to facilitate effective communication between the customer agency and shared services provider, reflecting observations found in out-sourcing literature. Research limitations/implications - Results point to significant challenges continuing to occur for shared services in healthcare. Risks identified suggest a more intimate relationship between clinical and support services than previously discussed. Originality/value - Previous discussion of the shared services model has not considered the skills, knowledge and ability required by staff in the customer agency. This research indicates that in the absence of such consideration, the concepts of the shared services model are weakened.
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Affiliation(s)
- Suzanne Kennewell
- Nutrition and Dietetics, Sydney Local Health District, Sydney, Australia
| | - Laura Baker
- Faculty of Business, University of Tasmania, Hobart, Australia
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Cleary M, Walter G, Hungerford CL. Recovery and the role of humility: insights from a case study analysis. Issues Ment Health Nurs 2014; 35:108-13. [PMID: 24502468 DOI: 10.3109/01612840.2013.838812] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
When the individuals comprising a profession are focused more on competition rather than service to others, and when holding a significant place on the world stage is held in higher esteem than meaningful collaboration with the disempowered, is it possible to be truly consumer-centred? This article considers the notion of humility in the context of recovery and the challenges to the effective implementation of recovery-oriented services that have been identified. Insights are drawn from a case study analysis of the implementation of recovery approaches to health care into a publicly-funded mental health service located in Australia. While challenges to the operationalization of recovery are complex, we argue that the professional quality of humility provides an important means by which genuine and meaningful collaboration can be achieved among health professionals, consumers, carers, and other stakeholders.
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Affiliation(s)
- Michelle Cleary
- School of Nursing and Midwifery, University of Western Sydney , NSW , Australia
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Health sector priority setting at meso-level in lower and middle income countries: lessons learned, available options and suggested steps. Soc Sci Med 2013; 102:190-200. [PMID: 24565157 DOI: 10.1016/j.socscimed.2013.11.056] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 11/25/2013] [Accepted: 11/29/2013] [Indexed: 11/23/2022]
Abstract
Setting priority for health programming and budget allocation is an important issue, but there is little consensus on related processes. It is particularly relevant in low resource settings and at province- and district- or "meso-level", where contextual influences may be greater, information scarce and capacity lower. Although recent changes in disease epidemiology and health financing suggest even greater need to allocate resources effectively, the literature is relatively silent on evidence-based priority-setting in low and middle income countries (LMICs). We conducted a comprehensive review of the peer-reviewed and grey literature on health resource priority-setting in LMICs, focussing on meso-level and the evidence-based priority-setting processes (PSPs) piloted or suggested there. Our objective was to assess PSPs according to whether they have influenced resource allocation and impacted the outcome indicators prioritised. An exhaustive search of the peer-reviewed and grey literature published in the last decade yielded 57 background articles and 75 reports related to priority-setting at meso-level in LMICs. Although proponents of certain PSPs still advocate their use, other experts instead suggest broader elements to guide priority-setting. We conclude that currently no process can be confidently recommended for such settings. We also assessed the common reasons for failure at all levels of priority-setting and concluded further that local authorities should additionally consider contextual and systems limitations likely to prevent a satisfactory process and outcomes, particularly at meso-level. Recent literature proposes a list of related attributes and warning signs, and facilitated our preparation of a simple decision-tree or roadmap to help determine whether or not health systems issues should be improved in parallel to support for needed priority-setting; what elements of the PSP need improving; monitoring, and evaluation. Health priority-setting at meso-level in LMICs can involve common processes, but will often require additional attention to local health systems.
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Obermann K, Scheppe J, Glazinski B. More than figures? Qualitative research in health economics. HEALTH ECONOMICS 2013; 22:253-257. [PMID: 23382119 DOI: 10.1002/hec.2906] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Smith N, Mitton C, Cornelissen E, Gibson J, Peacock S. Using evaluation theory in priority setting and resource allocation. J Health Organ Manag 2012; 26:655-71. [PMID: 23115910 DOI: 10.1108/14777261211256963] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Public sector interest in methods for priority setting and program or policy evaluation has grown considerably over the last several decades, given increased expectations for accountable and efficient use of resources and emphasis on evidence-based decision making as a component of good management practice. While there has been some occasional effort to conduct evaluation of priority setting projects, the literatures around priority setting and evaluation have largely evolved separately. In this paper, the aim is to bring them together. DESIGN/METHODOLOGY/APPROACH The contention is that evaluation theory is a means by which evaluators reflect upon what it is they are doing when they do evaluation work. Theories help to organize thinking, sort out relevant from irrelevant information, provide transparent grounds for particular implementation choices, and can help resolve problematic issues which may arise in the conduct of an evaluation project. FINDINGS A detailed review of three major branches of evaluation theory--methods, utilization, and valuing--identifies how such theories can guide the development of efforts to evaluate priority setting and resource allocation initiatives. Evaluation theories differ in terms of their guiding question, anticipated setting or context, evaluation foci, perspective from which benefits are calculated, and typical methods endorsed. ORIGINALITY/VALUE Choosing a particular theoretical approach will structure the way in which any priority setting process is evaluated. The paper suggests that explicitly considering evaluation theory makes key aspects of the evaluation process more visible to all stakeholders, and can assist in the design of effective evaluation of priority setting processes; this should iteratively serve to improve the understanding of priority setting practices themselves.
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Affiliation(s)
- Neale Smith
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada.
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Fischer KE. A systematic review of coverage decision-making on health technologies-evidence from the real world. Health Policy 2012; 107:218-30. [PMID: 22867939 DOI: 10.1016/j.healthpol.2012.07.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 05/30/2012] [Accepted: 07/09/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Quantitative analysis of real-world coverage decision-making offers insights into the revealed preferences of appraisal committees. Aim of this review was to structure empirical evidence of coverage decisions made in practice based on the components 'methods and evidence', 'criteria and standards', 'decision outcome' and 'processes'. METHODS Several electronic databases, key journals and decision committees' websites were searched for publications between 1993 and June 2011. Inclusion criteria were the analysis of past decisions and application of quantitative methods. Each study was categorized by the scope of decision-making and the components covered by the variables used in quantitative analysis. RESULTS Thirty-two studies were identified. Many focused on pharmaceuticals, the UK NICE or the Australian PBAC. The components were covered comprehensively, but heterogeneously. Seventy-two variables were identified of which the following were more prevalent: specifications of the decision outcome; the indications considered for appraisal, identification of incremental cost-effectiveness ratios, appropriateness of evaluation methods, type of economic or clinical evidence used for assessment, and the decision date. CONCLUSIONS Research was dominated by analysis of decision outcomes and appraisal criteria. Although common approaches were identified, the complexity of coverage decision-making - reflected by the heterogeneity of identified variables - will continue to challenge empirical research.
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Affiliation(s)
- Katharina Elisabeth Fischer
- Helmholtz Zentrum München - German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; University of Hamburg, Hamburg Center for Health Economics, Esplanade 36, 20354 Hamburg, Germany.
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