Discussion
Data comparison
The article by McDonald and Ollerenshaw (2011) focused on the benefits of priority setting that focuses on decision making in regards to the appropriate allocation of resources for addressing and identifying the most essential health issues. The authors elaborated on the operation of health prioritization at three levels, namely, the micro-, macro-, and meso-levels that have been validated by previous findings (Hipgrave et al., 2014). The basic benefits of the article lies in the fact that it identified a range of 13 factors, which are found to play a major role in setting priorities for specific community health plans that are prepared by major decision-makers in primary healthcare alliance. The authors defined data comparison as the process that focused on use of comparative epidemiological data for identifying the major health needs in a catchment (Alderman et al., 2013). The process generally involves conducting a comparison of the morbidity rates, mortality statistics, demographic profiles, community health and wellbeing, hospital admissions, and socio-economic disadvantage indicators. The availability of datasets enable the process of making comparisons at the local government area, community levels, state, and national level. The article also illustrated the importance of such comparisons in identifying differences existing in rural areas, and between metropolitan and rural populations, which have discrepancies in the health data. Similar findings were also presented by Viergever et al., (2010) who elaborated on the different methodological approaches that should be implemented during health research priority settings. The authors were accurate in preparing a checklist that contained exhaustive information on nine different themes.
The authors were accurate in stating out the phases of the preparatory phase namely, (1) deciding of the context of the factors that underpin the process of health prioritization (2) using a comprehensive approach (3) inclusiveness of key stakeholders in health research priorities (4) gathering of information (5) implementation planning. This can be considered as a correct approach since researching about the context of the prioritization process helps in determining the resources that are available, and the underlying principles or values that influence the same. While deciding on priorities, the authors emphasized on the importance of criteria selection that is imperative to setting priorities (Whitty & Littlejohns, 2015). Arriving at a consensus to decide on the major priorities that help in mitigating health inequalities are crucial. However, the data presented in the research article by Persad, Wertheimer and Emanuel (2009) emphasised on the importance of eight major ethical principles that guide the process of healthcare resource allocation. The major attributes that were identified by the authors focused on treating people equally, prioritarianism, utilitarianism, and social usefulness rewards. The trustworthiness of the identified themes can be attributed to the fact that favouring the disadvantaged people, specifically the young and the sick facilitates the process of delivery of optimal healthcare services, thereby reducing inequities.
Social determinants of health
Social determinants of health refer to environmental conditions in which the residents are born, learn, live, play, work, worship, and age. These determinants affect several aspects of health, functioning, thereby creating direct impacts on the quality-of-life (Braveman & Gottlieb, 2014). Healthy relationships exist between the health status of all residents of Riversland and their socioeconomic background. Men were found to have shorter life expectancy than women, in Riverlands. The different phases of approaches that have been taken up by the government are structural, intermediate, health and disability services and impacts. The aforementioned statements were further emphasized by McDonald who identified targeting of social determinants as the core principle for reducing health inequity. They economic, social and political conditions were accurately identified as the major factors that shape the distribution of health resources. Furthermore, similarities were with previous findings were also established by the fact that the authors formed a correlation between poor health outcomes and the economically disadvantaged population (Perrin, 2013). In addition, the upstream social determinants, such as, housing, employment, transport and education were correctly identified. The article by Viergever (2010) also presented similar findings that illustrated the role of gathering relevant information during priority settings. It focused on the collection of technical data required for informing discussion on major research priorities, such as intervention cost-effectiveness, disease burden, and determinants of disease. Insufficient investments on addressing the background or non-modifiable risk factors have been found to act as major barriers in the development of good preventive care services, thereby exacerbating the problem (Mihalopoulos et al., 2013).
Comparative risk factor assessment has shown significant benefits in comparing between the extents of their contribution to the incidence of major diseases that increase the disease burden of a locality. Briefly, disease burden studies are performed to for quantifying the disability-adjusted life years (DALYs), contributed by the disease conditions (Devleesschauwer et al., 2014). Thus, taking into account the background or risk factor information helps in the calculation of disease burden that can be attributable to specific risk factors (Kamuzora et al., 2013). It can be deduced form the previously conducted audit that there is a higher proportion of male smokers, when compared to females in Riverlands. While conducting a comparative risk assessment of disease burden that is attributable to tobacco, all diseases exacerbated by tobacco smoking are recognized, in addition to their relative risks of association between the disease and smoking, and the population distribution.
Scale of the problem
Priority setting in healthcare also involves recognition of the number of people, living in a particular region, who are affected by health inequities that directly result in poorer health outcomes among them. This generally encompasses setting agendas that aim towards common outcomes that focus on negotiated set of health priorities. This was elaborated by one article that identified scale of health problems as the number of people, present in a catchment, who are affected by the problem (directly or indirectly) (McDonald & Ollerenshaw, 2011). Demographical and epidemiological data play an important role in identifying the scale of health problem. In addition, the limitations were also appropriately identified owing to the use of unreliable or outdated data. Similar data were presented by Persad (2009) who illustrated the insufficiency of maximizing quality-adjusted life-years (QALY) for allocation of health resource. However, the article accurately identified the differences in QALYs that play an essential role in determining the basis of prioritizing the delivery health services. This can be further established by the fact that QALY is a generic measure of disease burden, and includes both the quantity and quality of life lived (Brennan & Dixon, 2013). Use of QALY in setting priorities is an important step as it facilitates the process of economic evaluation, which in turn helps in conducting a financial assessment of the selected medical interventions.
Aligning the priority with governments’ priorities and targets
There are a range of factors that shape the budget allocation and implementation of government policies while setting health priorities. The outcomes and values that are prioritized by the policymakers show important implications on health spending, thereby creating direct impacts on the population. Utilitarians have been found to focus on the utility, or value of the health decision that they will implement. It is generally believed by the utilitarians that the ends usually justify the means. Effective policy tools based on cost–effectiveness and cost–benefit analysis also reflect the major concerns associated with generation of greatest benefits, with the use of least possible resources (Yamin & Norheim, 2014). Forming an alignment of the healthcare priorities with that of the government refers to the process that helps in setting catchment health priorities, and correlating them with relevant jurisdictions. This straightforward procedure involves the process of formulating appropriate strategic plans, policy documents, and agreements related to funding that are set by the relevant state, local, and federal governments. These policies are most often reviewed for ensuring accordance with the catchment health priorities (Gu et al., 2015). Several priorities set up by the Victorian Department of Human Services have been accurately identified in the article. These government frameworks and priorities were established with the aim of addressing three major objectives that will help in reducing health inequities in the catchment area. The three major frameworks that are aligned with the government targets encompass promoting mental health and overall wellbeing, promoting moderate physical activity for achieving healthy communities, and promoting nutritious and accessible food.
However, government policy-making and its implementation is often considered as a contested and risky business. The members of health and welfare agency of the major government bodies and public health bodies obtain huge funding from different programs, organisations, departments, and government levels. The government creates several funding programs that cut across the time periods and geographical boundaries, thereby contributing to the potential for competing and overlapping priorities (Mehl & Labrique, 2014). Furthermore, the member agencies also play the part of competitors and collaborators for funding. Thus, there is a need to ensure that the catchment health priorities are well aligned with the stated targets and priorities of the government. This can be facilitated by formulation of administrative procedures that are interwoven by strategic decision-making and political positioning. Alignment of the health priorities with the targets of the governmental agencies have also been confirmed by another article that focused on the three principles of priority settings that are used for organ allocation by the United Nations for Organ Sharing (UNOS) (Persad). The three principles encompassed the sickest-first, first come first served, and prognosis. Identifying the current medical conditions of the residents of the catchment, reducing their waiting time based on the severity of the health condition and a proper prognosis are vital to accomplishing the intended goals of aligning the priorities. The fact that the process of setting health research priority provides assistance to policymakers and researchers in targeting their research effectively have been well accepted (Callahan, 2018). This in turn creates potential public health benefit. National health research priorities have also been found to play an important role in facilitating transformation of donor-driven research agendas to those policies or agendas that are driven by the needs of the low income countries.
On the other hand, liberals have always been found to adopt a rights–based approach that focuses on the allocation of primary or advanced healthcare resources. They hold the common belief that all humans possess the obligation and capacity of displaying mutual respect that often endows these individuals with some basic rights. The liberals, commonly referred to as libertarians, generally focus on negative rights that are imperative for guaranteeing individual freedom. Libertarians also focus on individual rights that pertain to select their physicians or buy health insurance (Stapleton et al., 2014). In contrast, egalitarian liberals have also been found to emphasize on positive rights, or minimum services and resources that guarantee the ability of an individual to exercise free choices, which in turn will facilitate the process of aligning the priorities (Lombardi, Miyagishima & Veneziani, 2016). The government policymakers might adopt a communitarian or utilitarian perspective, with the objective of prioritizing their health interventions that are based the major objective utilities. Furthermore, the ethical values of the government can also be modified, which in turn would facilitate gaining a sound understanding of the needs and abilities of the particular population.
Assessing financial outcomes
No perfect formula exists that can help in determining or identifying the major health interventions areas that need prioritization. This creates limits on the analysis of cost–effectiveness of the priorities related to policymaking. Absence of a universal consensus regarding the principles for prioritization, effective approaches need to be adopted by the governments for allocating resources, thereby justifying the policies (Baumbach & Gulis, 2014). The process of setting priorities always involves making relevant choices that are concerned with accomplishing positive outcomes and reducing costs of negative outcomes. Hence, financial cost that does not address the problem is a major attribute of the health priority settings (De Vogli, 2014). Similar findings were also presented by Persad (2009) who suggested that people suffering from severe health abnormalities such as, sickle cell anemia, with clear and small chances of benefits might not have medical needs. Deciding on the priorities is also influenced by a set of criteria that encompass the magnitude of the problems and the cost-effectiveness of the programs (Viergever et al., 2010). The Productivity Commission, National Centre for Social and Economic Modelling, and Australian Institute of Health and Welfare have calculated the costs of several reforms, initiatives, and health problems that have assisted in the procedure of setting health priorities (Gopalan et al., 2014).
Potential for improvement
These policies and strategies adopted by the government ensure that health inequalities that have been properly identified are reduced to their bare minimum, upon their appropriate implementation. Adoption of appropriate strategies systems will promote gender equity, strengthen the nationals and local government and improve the overall health of vulnerable individuals. Efforts must be taken by all the government agencies to bring about improvements in minimizing inequities that exist in the health sector, thereby shattering the shackles of poverty and health access inequalities. Provisions must be created for mechanisms related to disputes and challenges, which in turn would provide opportunities for improvement and revision of those policies, in regards to new arguments evidences.
Conclusion:
To conclude, enforcing policies and legislation that increase the government funding that are spent on health priority identification and reduction are alone not efficient to improve the major health outcomes, in cases when the funds are not efficiently spent. Health outcomes can be improved if there is an increase in the efficiency of government health spending, without total budget expenditure increase. Increases in the efficiency of health spending among all nations would also result in an elevation in the regional average of life expectancy. Furthermore, universal health coverages should also be given their due recognition owing to the impacts that they exert on health related financial risk protection. There is a need to create provisions for increasing the budget allocation related to health. An improvement in the population health will create significant economic impacts on the entire nation. Thus, it can be concluded that achievement of better health outcomes will provide a sound return on the investments, in the forms of stronger economic growth and output.
Major healthcare systems have been found to face severe problems that are related to efficiency and justice, often associated with setting specific priorities. These priorities facilitate the process of allocation of a restricted or limited pool of health resources to a particular population. One of the major challenges encountered by the healthcare systems can be attributed to the scarcity or limitations in the amount of necessary resources, thereby creating difficulties to provide all individuals with all kinds of effective interventions that they might want or need (Norheim et al., 2014). These scarcity or inadequacy of resources often raises several questions that pertain to efficiency and justice, in the target population. Health care rationing or priority setting has gained wider recognition in recent years. There is a need to explicitly address the priority setting in the field of public health, for developing improved methods that help in allocation of scarce healthcare resources, which in turn leads to the development of public dialogue that ensures legitimacy. There is mounting evidence for the fact that addressing the social determinants appropriately will help in eliminating all kinds of health inequities in Victoria (Baum & Fisher, 2014). Health inequalities were not a matter of concern for the Department of Health. Nevertheless, the necessity of reducing health inequities has been acknowledged by the government. This essay will compare and contrast three different articles that have focus on priority settings in healthcare and will also identify the scale of the health inequality problem and align the priorities, recognized by the researchers with the targets and priorities of the government.
References:
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Baum, F., & Fisher, M. (2014). Why behavioural health promotion endures despite its failure to reduce health inequities. Sociology of health & illness, 36(2), 213-225.
Baumbach, A., & Gulis, G. (2014). Impact of financial crisis on selected health outcomes in Europe. The European Journal of Public Health, 24(3), 399-403.
Braveman, P., & Gottlieb, L. (2014). The social determinants of health: it’s time to consider the causes of the causes. Public health reports, 129(1_suppl2), 19-31.
Brennan, V. K., & Dixon, S. (2013). Incorporating process utility into quality adjusted life years: a systematic review of empirical studies. Pharmacoeconomics, 31(8), 677-691.
Callahan, D. (2018). Is Rationing Inevitable?. Rationing and Resource Allocation in Healthcare: Essential Readings, 311(24), 26.
De Vogli, R. (2014). The financial crisis, health and health inequities in Europe: the need for regulations, redistribution and social protection. International journal for equity in health, 13(1), 58.
Devleesschauwer, B., Havelaar, A. H., De Noordhout, C. M., Haagsma, J. A., Praet, N., Dorny, P., … & Speybroeck, N. (2014). Calculating disability-adjusted life years to quantify burden of disease. International journal of public health, 59(3), 565-569.
Gopalan, S. S., Mutasa, R., Friedman, J., & Das, A. (2014). Health sector demand-side financial incentives in low-and middle-income countries: a systematic review on demand-and supply-side effects. Social science & medicine, 100, 72-83.
Gu, Y., Lancsar, E., Ghijben, P., Butler, J. R., & Donaldson, C. (2015). Attributes and weights in health care priority setting: a systematic review of what counts and to what extent. Social Science & Medicine, 146, 41-52.
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Kamuzora, P., Maluka, S., Ndawi, B., Byskov, J., & Hurtig, A. K. (2013). Promoting community participation in priority setting in district health systems: experiences from Mbarali district, Tanzania. Global health action, 6(1), 22669.
Lombardi, M., Miyagishima, K., & Veneziani, R. (2016). Liberal egalitarianism and the Harm Principle. The Economic Journal, 126(597), 2173-2196.
McDonald, J., & Ollerenshaw, A. (2011). Priority setting in primary health care: a framework for local catchments. Rural Remote Health, 11(2), 1714.
Mehl, G., & Labrique, A. (2014). Prioritizing integrated mHealth strategies for universal health coverage. Science, 345(6202), 1284-1287.
Mihalopoulos, C., Carter, R. O. B., Pirkis, J., & Vos, T. (2013). Priority-setting for mental health services. Journal of Mental Health, 22(2), 122-134.
Norheim, O. F., Baltussen, R., Johri, M., Chisholm, D., Nord, E., Brock, D., … & Fleurbaey, M. (2014). Guidance on priority setting in health care (GPS-Health): the inclusion of equity criteria not captured by cost-effectiveness analysis. Cost Effectiveness and Resource Allocation, 12(1), 18.
Perrin, V. A. (2013). Social determinants of health. Health Affairs, 32(11), 2060-2060.
Persad, G., Wertheimer, A., & Emanuel, E. J. (2009). Principles for allocation of scarce medical interventions. The Lancet, 373(9661), 423-431.
Stapleton, G., Schröder-Bäck, P., Brand, H., & Townend, D. (2014). Health inequalities and regional specific scarcity in primary care physicians: ethical issues and criteria. International journal of public health, 59(3), 449-455.
Viergever, R. F., Olifson, S., Ghaffar, A., & Terry, R. F. (2010). A checklist for health research priority setting: nine common themes of good practice. Health research policy and systems, 8(1), 36.
Whitty, J. A., & Littlejohns, P. (2015). Social values and health priority setting in Australia: an analysis applied to the context of health technology assessment. Health Policy, 119(2), 127-136.
Yamin, A. E., & Norheim, O. F. (2014). Taking equality seriously: applying human rights frameworks to priority setting in health. Human Rights Quarterly, 36(2), 296-324.
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