In September 2015, the Sustainable Development Goals, a set of 17 targets to be reached across the world by 2030, were set. The third goal, which is to ‘ensure healthy lives and promote well-being for all’ can be seen as motivation to implement universal health coverage (UHC) in all countries around the world, which is an excellent way in which to ensure population health, equity and social development.
One of the largest debates in UHC is how one decides which medical interventions should be provided under UHC. Priority setting, whereby finite resources can be directed towards cost-effective and appropriate treatment and prevention strategies, is used to do this, and this was the focus of the conference.
Accountability and fairness in priority setting
In order to prioritise certain interventions, other interventions need to be deprioritised, and these decisions need to be evidence-based. This is the essence of health technology assessments (HTA), which therefore have a fundamental role in UHC and health policy.
Although cost-effectiveness regarding the cost/benefit ratios help in the decision-making within some of these HTAs, other criteria are also used. For instance, should the age of a sick individual or population be considered, or the lifestyle choices that they make?
Ole Norheim gave an excellent presentation regarding ethics and transparency within HTAs. He highlighted that there are relevant social values that should be considered, and that these should be incorporated into the decision-making process. This was a much debated issue as some of these values and criteria needed to inform decision-making are hotly contested.
How can policy makers shape the research agenda?
Priority setting relies on evaluation and interpretation of good quality evidence. In an excellent session chaired by Sue Hill, various stakeholders discussed the decision-making process regarding generation of that evidence.
Who decides what research should be undertaken, and how is this decided? There are three stakeholders involved here: policy makers, researchers and funders, and a large amount of collaboration is required in order to move the process forward.
Tom Walley discussed his role as a funder and researcher within the National Institute for Health Research in this process. Here, the research agenda is based upon the health needs of patients and the public, aims to fill the research gaps in the current literature.
The evidence generated then goes on to inform NICE guidelines. On the other side of the coin, Siddhi Aryal, a researcher at the Malaria Consortium, discussed his challenges regarding getting approval for his research projects, highlighting ways in which to engage policymakers.
The take home message from this session was that one should always consider what it is that policy makers need from researchers in order for them to implement an intervention. Some of these issues have recently been discussed in an Editorial in BMC Medicine.
UHC experiences from around the world
Thailand is a well-placed venue for discussions on priority setting for UHC. It implemented UHC in 2002, and has become a good example for other countries to follow.
Piyasakol Sakolsatayador, the Minister of Public Health in Thailand explained how HITAP, which is Thailand’s HTA agency, was formally integrated into UCH in 2009, and helps to provide evidence-informed priority setting.
Amy Khor, the Senior Minister of State for Health in Singapore, drew on Singapore’s UHC experiences of both the collective and individual responsibility approach.
Amy Khor, the Senior Minister of State for Health in Singapore, drew on Singapore’s UHC experiences of both the collective and individual responsibility approach. Here, Medisure is used, where co-payment is required from the public, but the government still subsidises healthcare.
This ensures that individuals are more are of the cost of their lifestyle choices on their health, and also reduces inappropriate overconsumption.
How can a triangle move a mountain?
One of the main debates from the meeting was the concept of the ‘triangle moving the mountain’- how can something complex, such as UHC, be resolved under finite resources?
The triangle in this case refers to three concepts: knowledge and evidence; civil society; political activity. In other words, researchers, the public (and the needs of the public) and policy makers need to collaborate in order to make the best decisions for health care.
Overall, the presentations at the Prince Mahidol Award conference have stimulated debate in these areas, and hopefully push UHC to be an obtainable target for the sustainable development goals.
BMC Medicine will be launching a new article collection in late 2016, Medicines and the Future of Health, in collaboration with the Journal of Pharmaceutical Policy and Practice (JoPPP). This collection will cover recent advances in drug and diagnostics development, precision medicine, medicines use, policy and access, that have both broad interest and high clinical and public health relevance due to their impact on the future of health.
If you have any research you would like us to consider for inclusion in our Medicines and the Future of Health collection, please email the journal at email@example.com.
BMC Medicine: passionate about quality, transparency and clinical impact
2015 median turnover times: initial decision three days; decision after peer review 40 days