Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Int J Health Policy Manag. 2016 Nov 1;5(11):615-618. doi: 10.15171/ijhpm.2016.83.
Priority setting of health interventions is generally considered as a valuable approach to support low- and middle-income countries (LMICs) in their strive for universal health coverage (UHC). However, present initiatives on priority setting are mainly geared towards the development of more cost-effectiveness information, and this evidence does not sufficiently support countries to make optimal choices. The reason is that priority setting is in reality a value-laden political process in which multiple criteria beyond cost-effectiveness are important, and stakeholders often justifiably disagree about the relative importance of these criteria. Here, we propose the use of 'evidence-informed deliberative processes' as an approach that does explicitly recognise priority setting as a political process and an intrinsically complex task. In these processes, deliberation between stakeholders is crucial to identify, reflect and learn about the meaning and importance of values, informed by evidence on these values. Such processes then result in the use of a broader range of explicit criteria that can be seen as the product of both international learning ('core' criteria, which include eg, cost-effectiveness, priority to the worse off, and financial protection) and learning among local stakeholders ('contextual' criteria). We believe that, with these evidence-informed deliberative processes in place, priority setting can provide a more meaningful contribution to achieving UHC.
优先考虑卫生干预措施通常被认为是支持低收入和中等收入国家（LMICs）实现全民健康覆盖（UHC）的一种有价值的方法。然而，目前的优先事项设定举措主要侧重于开发更具成本效益的信息，而这些证据并不能充分支持国家做出最佳选择。原因是，优先事项设定实际上是一个充满价值的政治过程，除了成本效益之外，还有许多其他重要标准，利益相关者往往对这些标准的相对重要性存在合理的分歧。在这里，我们提出使用“基于证据的审议过程”作为一种方法，该方法明确认识到优先事项设定是一个政治过程，也是一个内在复杂的任务。在这些过程中，利益相关者之间的审议对于确定、反映和了解价值观的意义和重要性至关重要，这些价值观的证据为审议提供了依据。这些过程随后导致使用更广泛的明确标准，这些标准可以被视为国际学习（“核心”标准，包括成本效益、优先考虑处境较差者以及财务保护）和当地利益相关者之间学习的产物（“背景”标准）。我们相信，通过这些基于证据的审议过程，优先事项设定可以为实现全民健康覆盖做出更有意义的贡献。
