How reforms hamper priority-setting in health care: an interview study with local decision-makers in London

Area of Science:

• Health Services Research
• Health Policy and Management
• Bioethics

Background:

• Equitable allocation of scarce health resources is a critical challenge for healthcare systems globally.
• Existing priority-setting approaches often rely on health economic analyses or procedural justice principles.
• Empirical data on factors influencing local-level healthcare priority-setting remains limited.

Purpose of the Study:

• To explore how healthcare planners at the meso-level make decisions regarding service funding and prioritization.
• To assess the extent to which principles of fair priority-setting are considered in these decisions.
• To identify practical challenges and political realities impacting the implementation of fair priority-setting.

Main Methods:

• Qualitative interview study with healthcare commissioners and stakeholders.
• Conducted in South London between 2017 and 2018.
• Analysis of decision-making processes in healthcare priority-setting.

Main Results:

• Interviewees recognized the importance of fairness principles like transparency and accountability.
• Adherence to these principles is practically constrained by conceptual and operational difficulties.
• Political realities and ongoing reform processes further complicate the application of fair prioritization.

Conclusions:

• Current frameworks for healthcare priority-setting may not adequately address contextual and political factors.
• Integrating insights from policy and political sciences is crucial for adapting these frameworks.
• Recommendations are proposed to better incorporate context and politics into priority-setting considerations.