Priority setting is one of the major questions of the 21st century also referred to as resource allocation or rationing. It is so widespread and context specific, improving this process of prioritization in a health system implies to improving it in the institutions that make up the system (Martin and Singer, 2003). Priority setting of health interventions is vital for achieving health system goals, which are broadly described as health maximization, decreasing inequities in health and reduction of financial burden against the costs of ill health (Voorhoeve et al., 2017)(Kutzin, 2013)(WHO Consultative Group on Equity and Universal Health Coverage, 2014). Currently the methods and guidelines used for priority settings do not completely address a full range of health related objectives with greater emphasizes only on the first objective of health maximization(Tromp and Baltussen, 2012). It is the responsibility of decision makers and the other responsible authorities to balance health maximization with equity and financial protection in order to have far reaching implications for which health priorities are agreed and pursued (Norheim et al., 2014).
Since we have to fulfill challenging demands in the health care system there is a need to prioritize and make fair choices for the allocation of resources. Prioritization in health care has grown with time and is not new to developed or developing world. In many countries it has become more explicit along with the resource constraints and increased demands enabling the decision makers to address this concern more openly. We already know that there is no easy way to set priorities and distribute health resources in a health care system. When setting priorities it is very frequent for the decision makers to have disagreements and difference of opinion over the guiding principles which sometimes makes the entire process more speculative or either impartial or unfair from the perspective of user. Moreover to yield maximum health gains many countries have established clear principles and regulatory authoritative bodies that run the priority setting process in a way that is fair, equitable, affordable and incorporates national values and aspirations. Different countries have used different alternatives of setting priorities depending upon their contextual settings, culture and traditions. Presently the World Health Organization (WHO) provided a checklist for equity guidelines relevant for priority setting in health care (GPS-Health). The principles of priority setting guidelines of GPS-Health as recommended by WHO are as follows.
Principles of priority setting
The priority setting in health care is an inevitable process which involves choices and decisions that may influence people in a positive or negative way. Therefore, the decision makers who are involved in decision making are accountable for their intended decisions. It is their responsibility to justify their actions or decisions to all affected parties. Furthermore the decisions should also reflect country’s social values concerned with health maximization, distribution and protection against financial losses. Within a given budget cost effectiveness analysis determines how to allocate resources in order to maximize health gains or sometimes either considers societal willingness to pay estimates relative to a threshold level (Drummond et al., 2005).
Moreover, distribution of health care implies to fair and equitable chance for all people to lead a long and healthy life (Williams, 1997). The following principle can be further expressed in terms of vertical equity (i.e.; those with unequal needs should receive different or unequal health care lies in the criteria of disease and target intervention) and horizontal equity (i.e.; equity between those with equal health care needs that is pertinent to the second criteria for different characteristics of social groups an intervention targets) (Culyer and Wagstaff, 1993) (Musgrove, 1999). Later on the policy recommendations may be based on the type of analysis either cost effectiveness analysis or equity analysis. Priority setting in case of cost effectiveness analysis is concerned with absolute health gains while the later one deals with the distribution of these health gains among the people of population. This could lead to marked differences when prioritizing i.e.; If we consider the example of HIV/AIDS epidemic, here cost effectiveness analysis recommends strategies for the provision of universal testing and early diagnosis so as to combat and reduce the HIV epidemic (Hontelez et al., 2013) while decision based on equity analysis would suggest prioritization of severely ill patients, more emphasis on poor people residing in rural areas, providing them treatment through mobile treatment services and food subsidies (Baltussen et al., 2013).
Criteria for priority setting
The GPS-Health provides criteria which comprise of three groups which are concerned with:
a) Criteria concerned with disease and target intervention;
It includes following aspects;
Severity- Severity of the disease is identified by accessing the current and future health status, future health gaps and cost effectiveness analysis of target intervention.
Realization of potential – Priority (Fair chance) is given to those who benefit most from the treatment.
Past health loss- Everyone has an equal chance to live a long healthy life and fulfill their life plans.
b) Criteria pertaining to the different characteristics of social groups;
Targeting health interventions to the disadvantaged groups for instance; people with lower socioeconomic status and compensating them according to the social determinants of health.
c) Criteria for financial and social consequences;
Prioritizing health interventions for the welfare of people and further preventing the loop of poverty. Financial protection matters more to the decision makers even if the intervention is cost ineffective.