Friday, September 30, 2011

[EQ] Setting priorities in health

Setting priorities in health

A study of English primary care trusts

Research report: Suzanne Robinson, Helen Dickinson, Iestyn Williams, Tim Freeman, Benedict Rumbold and Katie Spence

Health Services Management Centre, University of Birmingham and the Nuffield Trust

September 2011

Available online PDF [84p] at: http://bit.ly/nJstO4

The research reported in this document was designed to map the priority-setting activities taking place across the National Health Service (NHS) in England, and to explore and assess the effectiveness of these practices within specific local contexts.

The questions that provided the basis for the research were as follows:

• What priority-setting tools, processes and activities are practised currently as part of the commissioning processes of English primary care trusts (PCTs)?

• What barriers are experienced by PCTs seeking to implement explicit priority setting, and how are these being addressed?

• What other strengths and weaknesses can be identified in current priority-setting practice?

• What learning can be derived that will be instructive for future priority setting within the NHS and elsewhere?

Content:

Key messages from the research

1. Background and context

Understanding priority setting

Priority setting and commissioning

The challenges facing priority-setters

Research on local priority setting in England

Research scope and aims

2. Methodology

Stage 1: National survey

Stage 2: In-depth case studies

Data collection

Data analysis and reporting

Setting priorities in health: a study of English primary care trusts

3. Priority setting: the national picture

Developments in local priority-setting processes

Remit and scope of priority-setting arrangements

Stakeholder involvement in decision making

Use of evidence and decision tools

Use of decision tools in priority setting

Strengths and weaknesses of priority-setting processes

Disinvestment decisions

4. In-depth exploration of priority setting

Rationale for forming priority-setting processes

Key features of the case study priority-setting processes

Formal decision criteria

Decision processes

Role of discussion and deliberation

Technocratic approaches to aid priority setting: the evidence-based approach

Stakeholder involvement in priority setting

Engagement and involvement of health and social care organisations

Engagement and involvement of the public and patients

Implementation

Leadership

Overall coherence and ‘success’ of priority-setting processes

Response to the White Paper: the impact of government reforms on priority setting

5. Discussion

Decision tools

Outcomes of priority-setting work

Non-technical dimensions of priority setting

Engaging stakeholders and the public

Political dimensions of priority setting

Leadership

Information resources and expertise

Impact of government reforms on priority setting

6. Conclusions and recommendations

Key policy drivers

Governance

Technical challenges

System-wide approach to priority-setting

Political realities

 

Recommendations

 

References

Appendix: Different types of priority-setting activity to be considered

 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]
Washington DC USA

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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[EQ] Expert Review and Proposals for Measurement of Health Inequalities

Expert Review and Proposals for Measurement of Health Inequalities in the European Union


Spinakis A, Anastasiou G, Panousis V, Spiliopoulos K, Palaiologou S, Yfantopoulos J

Full Report. (2011) European Commission

Directorate General for Health and Consumers. Luxembourg. ISBN 978-92-79-18528-1

Full Report available online PDF file [202p.] at: http://bit.ly/n9mSVI

Summary PDF file [39p.] at: http://bit.ly/pLATPK

"…..Monitoring of inequalities in health is an important public health task. Interest in health inequalities among EU countries and their regions as well as among the various social clusters in the EU population is growing.


The search for the best appropriate "summary measure" of health inequality that can be observed individually or in terms of groups of individuals, is a task that occupies a lot the researchers involved in the fields of inequality research.

Lately in the EU, it has been recognized that a more focused effort is required. It is more natural to suggest and construct methodologies or indices that will be suitable for assessing trends in terms of mortality, morbidity and also self-perceived health. The selection of an appropriate indicator or an appropriate measurement methodology for health inequality across the EU-27 countries is a demanding task. Each available indicator has advantages and disadvantages.


Simple indicators are usually comprehensive but may not have some specific desirable characteristics. Other indicators are more technical and difficult to understand, apply and/or interpret, but can assist more in explaining significant components of the concept "health inequality". Complex indicators can also be very useful in the decomposition of inequality. Based on the above, it is reasonable to state that one main goal in the study of health inequalities is to,

- propose appropriate measurement methods in the form of indicators that "estimate" and "capture" the exact level of inequality in a population
  (here the EU population).

The other very important goal of this study is to monitor the variation of health inequalities in all levels of analysis
 (e.g. social groups, regions, individuals) through time. Thus, perform a trend analysis.

The main objective was to contribute in the area of "Monitoring Health Inequalities in the EU", by combining the best practices in health inequalities measurement with the most reliable data that can be used to calculate these measures.

The specific tasks of the project were:

- the review and analysis of the existing work done in the measurement of health inequalities in the EU.

- the review and analysis of the existing and planned data sets available across the EU, with an assessment of their suitability for the purposes of the analysis.

 

Content:

Executive Summary

1.Introduction

2. Measurement of Health & Health inequalities in the EU – Conceptual framework

2.1 Health data - Health Indicators

2.2 What is Health Inequality?

2.3 Measurement of health inequality in the EU – A historical review

2.4 Inequality Indicators - Definitions & Classifications

3. Most suitable summary measures for monitoring health inequalities in the EU

3.1 Which indicators do we need? - What do we need to measure?

3.2 Inequalities in mortality across the EU area, regions and time

3.2.1 Proposed Indicators

3.2.2 Inequalities in the EU - Analysis of trends

3.3 Inequalities in Perceived Health Status and other Self Assessed Morbidity by SES groups in the EU

3.3.1 Proposed Indicators

3.3.2 Inequalities in the EU - Analysis of trends

3.4 Inequalities in Disability & Activity Limitations by SES groups in the EU

4. Concluding Remarks

Bibliography


ANNEX I: Index of Tables & Figures

ANNEX II: Tables

ANNEX III: Figures

ANNEX IV: Conceptual Framework to Measurement and Monitoring Health Inequalities

ANNEX V: Classification of Health Inequalities Measurement Techniques

ANNEX VI: Preliminary Evaluation of health Inequality Indicators & Desirable Properties

ANNEX VII: Health Inequalities Measurement by Social Groups - Core Social Variables

ANNEX VIII: EU Survey Tools & Questions

 

 

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 *      *     *
This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]
Washington DC USA

"Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members".
------------------------------------------------------------------------------------
PAHO/WHO Website
Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html
Twitter http://twitter.com/eqpaho





IMPORTANT: This transmission is for use by the intended
recipient and it may contain privileged, proprietary or
confidential information. If you are not the intended
recipient or a person responsible for delivering this
transmission to the intended recipient, you may not
disclose, copy or distribute this transmission or take
any action in reliance on it. If you received this transmission
in error, please dispose of and delete this transmission.

Thank you.