From the trenches: views from decision-makers on health services priority setting

Area of Science:

• Health Services Research
• Health Economics
• Public Health Policy

Background:

• Healthcare systems face resource scarcity, necessitating strategic funding decisions.
• Programme budgeting and marginal analysis (PBMA) is a widely adopted priority-setting framework.
• Existing PBMA applications are predominantly at the micro-level within specific care programs.

Purpose of the Study:

• To adapt and refine the PBMA framework for macro-level application across major service areas.
• To identify key issues and considerations for decision-makers in real-world health priority setting.
• To inform the development of PBMA at a macro level within a specific health authority and similar regionalized contexts.

Main Methods:

• A participatory action research project involving researchers and decision-makers.
• Qualitative analysis of decision-makers' perspectives on health priority setting.
• Examination of factors influencing macro-level PBMA implementation.

Main Results:

• Identified critical themes for decision-makers: comparing disparate patient groups, managing political influences, utilizing diverse evidence forms, acknowledging innovations, and engaging the public.
• Highlighted the need for a macro-level approach to PBMA in health authorities.
• Provided insights into the practical challenges and facilitators of implementing PBMA.

Conclusions:

• Macro-level PBMA refinement is crucial for effective resource allocation in health authorities.
• Understanding decision-maker priorities is essential for successful implementation of priority-setting frameworks.
• The findings offer valuable guidance for health organizations seeking to optimize resource allocation through evidence-informed priority setting.