title: Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative Processes, Not Just More Evidence on Cost-Effectiveness.
abstract: 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.
authors: Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
authors: Rob
authors: R
authors: Baltussen
authors: Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
authors: Maarten P
authors: MP
authors: Jansen
authors: Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
authors: Evelinn
authors: E
authors: Mikkelsen
authors: Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
authors: Noor
authors: N
authors: Tromp
authors: Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.|Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA.|Africa Centre for Population Health, Mtubatuba, South Africa.
authors: Jan
authors: J
authors: Hontelez
authors: Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
authors: Leon
authors: L
authors: Bijlmakers
authors: Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
authors: Gert Jan
authors: GJ
authors: Van der Wilt
mesh_terms: D003362:Cost-Benefit Analysis; D003906:Developing Countries; D006291:Health Policy; D006292:Health Priorities; D006801:Humans; D011057:Politics; D012945:Social Values; D019472:Universal Health Insurance
keywords: Cost-Effectiveness Analysis; Decision-Making; Evidence-Informed Deliberative Processes; Legitimacy; Priority Setting; Universal Health Coverage (UHC)