Budget- and Priority-Setting Criteria at State Health Agencies in Times of Austerity: A Mixed-Methods Study

Leider, Jonathon P.; Resnick, Beth; Kass, Nancy E.; Sellers, Katie; Young, Jessica; Bernet, Patrick; Jarris, Paul E.

doi:10.2105/ajph.2013.301732

Cited by 12 publications

(18 citation statements)

References 18 publications

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“…33, No. 1,2016 health reimbursement decision-making frameworks unique and very specific to their own local settings. Equity criteria relate to tackling inequalities and distributional impact.…”

Section: Discussionmentioning

confidence: 99%

“…For this reason, public health practitioners admit that political interests are among the most important decision-making criteria, which are to be weighed against other considerations. Some stakeholders even regard political pressure as an essential constraint within which public health systems have to operate (1). Researchers explained this phenomenon with the need for an effective public health leader engagement in the political arena to ensure sufficient funding (1).…”

Section: Discussionmentioning

confidence: 99%

“…Implementation of objective and verifiable criteria for decisions, and the availability of remedies for negative decisions are often stated among the most difficult barriers on the way to successfully address HTA issues in Eastern Europe (7). Moreover, there is a globally growing interest in the systematic setting of priorities in public health reimbursement decisionmaking (1).…”

Section: Drug Reimbursement Decision-making -An Even Bigger Problem Imentioning

confidence: 99%

“…Our pilot research focused on one particular component of this process -the criteria used -because of the critical role criteria are found to have in setting budgets and priorities in the field of public health (1). The analysis pursued two objectives: to identify important criteria relevant to drug reimbursement decision-making and to unveil relationships between theory and practice.…”

Section: Aim Of the Studymentioning

confidence: 99%

“…33, No. 1,2016 to the list of reimbursement decision-making variables, currently defined and used in Bulgaria (9,12).…”

Section: Selection Of Respondentsmentioning

confidence: 99%

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Criteria for Drug Reimbursement Decision-Making: An Emerging Public Health Challenge in Bulgaria

Искров

Стефанов

2016

Balkan Med J

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Background: During times of fiscal austerity, means of reimbursement decision-making are of particular interest for public health theory and practice. Introduction of advanced health technologies, growing health expenditures and increased public scrutiny over drug reimbursement decisions have pushed governments to consider mechanisms that promote the use of effective health technologies, while constraining costs. Aims: The study's aim was to explore the current rationale of the drug reimbursement decision-making framework in Bulgaria. Our pilot research focused on one particular component of this process -the criteria used -because of the critical role that criteria are known to have in setting budgets and priorities in the field of public health. The analysis pursued two objectives: to identify important criteria relevant to drug reimbursement decision-making and to unveil relationships between theory and practice. Study Design: Cross-sectional study. Methods: The study was realized through a closedended survey on reimbursement criteria among four major public health stakeholders -medical professionals, patients, health authorities, and industry. Empirical outcomes were then cross-compared with the theoretical framework, as defined by current Bulgarian public health legislation. Analysis outlined what is done and what needs to be done in the field of public health reimbursement decision-making. Results: Bulgarian public health stakeholders agreed on 15 criteria to form a tentative optimal framework for drug reimbursement decision-making. The most apparent gap between the empirically found preferences and the official legislation is the lack of consideration for the strength of evidence in reimbursement decisions. Conclusion: Bulgarian policy makers need to address specific gaps, such as formal consideration for strength of evidence, explicit role of efficiency criteria, and means to effectively empower patient and citizen involvement in public health decision-making. Drug reimbursement criteria have to be integrated into legitimate public health decision support tools that ensure the achievement of national public health objectives. These recommendations could be expanded to all Eastern European countries who share common public health problems.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Drug Reimbursement Decision-making -An Even Bigger Problem Imentioning

confidence: 99%

Section: Aim Of the Studymentioning

confidence: 99%

“…33, No. 1,2016 to the list of reimbursement decision-making variables, currently defined and used in Bulgaria (9,12).…”

Section: Selection Of Respondentsmentioning

confidence: 99%

See 3 more Smart Citations

Criteria for Drug Reimbursement Decision-Making: An Emerging Public Health Challenge in Bulgaria

Искров

Стефанов

2016

Balkan Med J

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Health Technology Assessment and Appraisal of Therapies for Rare Diseases

Искров¹,

Митева-Катранджиева²,

Стефанов³

2017

Advances in Experimental Medicine and Biology

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Innovative rare disease therapies and health technology assessment (HTA) share a lot of similarities. Both represent cases of interaction of epidemiology and health economics. Both are relatively new topics in public health practice. And both pose a lot of challenges to rare disease stakeholders who are currently looking for tools to support the timely access to innovative treatments while putting budget spending in order. This is why optimisation of assessment and appraisal of new rare disease therapies is a fundamental issue in rare disease health policy. Rare disease patients and caregivers expect prolonged life expectancy and improved quality of life and they perceive innovative health technologies as a rightful way to achieve these objectives.Multi-criteria decision analysis (MCDA) provides a structured, transparent approach to identify preferred alternatives by means of combined calculation of relative importance of different criteria and performance of the alternatives on these criteria. The labyrinth of competing interests and numerous stakeholders involved is why innovative rare disease health technologies make an excellent case study of the integration between HTA and MCDA. This kind of formalisation of decision-making is perceived as fair and legitimate, leading to a balance and agreement. MCDA provides a stage for a debate of policy priorities, health system specifics and societal attitudes, while also addressing the impact of rarity on all criteria and considerations.

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An institutional ethnography of political and legislative factors shaping online sexual health service implementation in Ontario, Canada

MacKinnon

Gómez-Ramírez

Worthington

et al. 2020

Critical Public Health

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Budget- and Priority-Setting Criteria at State Health Agencies in Times of Austerity: A Mixed-Methods Study

Abstract: We have presented empirical findings on criteria used in state health agency budgetary decision-making. These criteria suggested a focus and interest on core public health and the largest public health problems with the most serious ramifications.

Cited by 12 publications

References 18 publications

Criteria for Drug Reimbursement Decision-Making: An Emerging Public Health Challenge in Bulgaria

Criteria for Drug Reimbursement Decision-Making: An Emerging Public Health Challenge in Bulgaria

Health Technology Assessment and Appraisal of Therapies for Rare Diseases

An institutional ethnography of political and legislative factors shaping online sexual health service implementation in Ontario, Canada

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