Priority Setting for Health Service Coverage Decisions Supported by Public Spending: Experience from the Philippines

Abstract

Abstract-Achievement of universal health coverage requires better allocative efficiency in health systems. Countries like the Philippines, however, do not have quality local data for these decisions. We present a method that applies existing global data, e.g., Global Burden of Disease and Disease Control Priorities project, into creating a local priority list of diseases and interventions that may be useful in providing a rational plan for expanding coverage of health services paid by public financing. In the context of the Philippines, this refers to the Department of Health for vertical programs like immunization and disease control, and the Philippine Health Insurance Corporation for inpatient and outpatient health services. We found that the top 48 (or 22%) of diseases account for 80% of total disability-adjusted life years (DALYs), reflecting a well-known concept in management, the Pareto principle. Due to its simplicity and widespread applicability, the Pareto principle facilitated interest in rational priority setting among high-level officials in the Philippine health sector. Priority setting must not be limited to disease burden and cost-effectiveness criteria. Our lists can be used after further deliberation and stakeholder consultation. Priority setting is a complex, value-laden process, and a purely utilitarian approach to prioritization may lead to further deterioration in the health status of vulnerable populations. We recommend that DOH and PHIC set up a joint, independent agency primarily responsible for implementing a sustainable, transparent, and participatory priority-setting process that will advise them on future service coverage expansions.

Optimising decentralisation for the health sector by exploring the synergy of decision space, capacity and accountability: insights from the Philippines

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Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017

“…Diseases ranked lower within a larger cause category also might not benefit from the large-scale, focused advocacy efforts for the leading causes of death yet represent important future targets for research and public health. A rational, disease-burden-based approach to priority setting for health policy, now being adopted in some countries, 41 might help to accelerate the scale-up of interventions that will have the largest impact on disability and premature death.…”

The Relative Importance and Stability of Disease Burden Causes Over Time: Summarising Regional Trends on Disease Burden for 290 Causes Over 28 Years

“…Health trends are continuously being analysed and presented by international collaborators (among others, GBD study 2018a; 2018b; 2018c; Jamison et al, 2018; World Health Organization (WHO), 2019), national academics and governments (among others, Bundhamcharoen et al 2011;Fadwa 2011;Gilmour et al 2014;Murray et al 2013;New Zealand Ministry of Health 2016;Stevens et al 2008;Wong et al 2018;Zhou et al 2019).…”