Priority setting (also known as resource allocation or rationing) occurs at every level of every health system and is one of the most significant health care policy questions of the 21st century. Because it is so prevalent and context specific, improving priority setting in a health system entails improving it in the institutions that constitute the system. But, how should this be done? Normative approaches are necessary because they help identify key values that clarify policy choices, but insufficient because different (...) approaches lead to different conclusions and there is no consensus about which ones are correct, and they are too abstract to be directly used in actual decision making. Empirical approaches are necessary because they help to identify what is being done and what can be done, but are insufficient because they cannot identify what should be done. Moreover, to be really helpful, an improvement strategy must utilize rigorous research methods that are able to analyze and capture experience so that past problems are corrected and lessons can be shared with others. Therefore, a constructive, practical and accessible improvement strategy must be research-based and combine both normative and empirical methods. In this paper we propose a research-based improvement strategy that involves combining three linked methods: case study research to describe priority setting; interdisciplinary research to evaluate the description using an ethical framework; and action research to improve priority setting. This describe-evaluate-improve strategy is a generalizable method that can be used in different health care institutions to improve priority setting in that context. (shrink)

Because the demand for health services outstrips the available resources, priority setting is one of the most difficult issues faced by health policy makers, particularly those in developing countries. Priority setting in developing countries is fraught with uncertainty due to lack of credible information, weak priority setting institutions, and unclear priority setting processes. Efforts to improve priority setting in these contexts have focused on providing information and tools. In this paper we argue that priority setting is a value laden and (...) political process, and although important, the available information and tools are not sufficient to address the priority setting challenges in developing countries. Additional complementary efforts are required. Hence, a strategy to improve priority setting in developing countries should also include: (i) capturing current priority setting practices, (ii) improving the legitimacy and capacity of institutions that set priorities, and (iii) developing fair priority setting processes. (shrink)

Family Drug and Alcohol Courts (FDAC) were introduced to England in 2008 following their development in the USA. Pilots launched across the country adopted a family-based strategy with the aim to improve outcomes for children that live with parents who misuse substances or alcohol. The numbers of children entering the care system has increased with ‘subsequent new borns’ being a particular concern frequently becoming ‘looked after’ by the state at birth. This article will focus upon an initial phase of a (...) study that tracked the establishment of an FDAC pilot. It reveals how the FDAC team collaborated with Judges and a diversity of professionals and parents to create conditions through which ground-breaking practice was forged. The environment created is unique as it is one fully set within the context of each family’s lived experience. Through this approach parents have become full participants in court proceedings as opposed to purely subject to them. As a result, significant numbers of children have remained with or been returned to their families. (shrink)

Recent research suggests that individuals with relatively weak global precedence (i.e., a smaller propensity to view visual stimuli in a configural manner) show a reduced face inversion effect (FIE). Coupled with such findings, a number of recent studies have demonstrated links between an advantage for feature-based processing and the presentation of traits associated with autism among the general population. The present study sought to bridge these findings by investigating whether a relationship exists between the possession of autism-associated traits (i.e., as (...) indicated by individuals’“autism quotient” [(AQ) and the size of the FIE. Participants completed an on-line study in which the AQ was measured prior to a standard face recognition task where half of the faces were inverted at test. The results confirmed that higher AQ levels were predictive of smaller FIEs. Implications for a common underlying factor relating to processing orientation are discussed. (shrink)

Recent research suggests that individuals with relatively weak global precedence (i.e., a smaller propensity to view visual stimuli in a configural manner) show a reduced face inversion effect (FIE). Coupled with such findings, a number of recent studies have demonstrated links between an advantage for feature‐based processing and the presentation of traits associated with autism among the general population. The present study sought to bridge these findings by investigating whether a relationship exists between the possession of autism‐associated traits (i.e., as (...) indicated by individuals’“autism quotient” [(AQ) and the size of the FIE. Participants completed an on‐line study in which the AQ was measured prior to a standard face recognition task where half of the faces were inverted at test. The results confirmed that higher AQ levels were predictive of smaller FIEs. Implications for a common underlying factor relating to processing orientation are discussed. (shrink)

We use a transmission chain method to establish how context and category salience influence the formation of novel stereotypes through cumulative cultural evolution. We created novel alien targets by combining features from three category dimensions—color, movement, and shape—thereby creating social targets that were individually unique but that also shared category membership with other aliens (e.g., two aliens might be the same color and shape but move differently). At the start of the transmission chains each alien was randomly assigned attributes that (...) described it (e.g., arrogant, caring, confident). Participants were given training on the alien‐attribute assignments and were then tested on their memory for these. The alien‐attribute assignments participants produced during test were used as the training materials for the next participant in the transmission chain. As information was repeatedly transmitted an increasingly simplified, learnable stereotype‐like structure emerged for targets who shared the same color, such that by the end of the chains targets who shared the same color were more likely to share the same attributes (a reanalysis of data from Martin et al., which we term Experiment 1). The apparent bias toward the formation of novel stereotypes around the color category dimension was also found for objects (Experiment 2). However, when the category dimension of color was made less salient, it no longer dominated the formation of novel stereotypes (Experiment 3). The current findings suggest that context and category salience influence category dimension salience, which in turn influences the cumulative cultural evolution of information. (shrink)

The purpose of this study was to explore the views of members of the general public regarding ethical issues in adult predictive genetic testing. The literature pertaining to ethical issues regarding to adult predictive genetic testing is largely restricted to the views of ‘experts’ who have emphasized informed consent, patent issues, and insurance discrimination. Occasionally the views of patients who have undergone genetic counselling and testing have been elicited, adding psychosocial and family issues. However, the general public has not had (...) the opportunity to contribute. In order to explore theatre as a health policy research tool, 1,200 audience members attended the play ‘Sarah’s Daughters’ in seven Canadian cities, following which audience discussions were audiotaped. This study performed a secondary qualitative analysis of the data to identify the ethical issues of adult predictive genetic testing important to members of the general public. The identified issues were: (1) need for public education; (2) choice to undergo genetic counselling and testing; (3) access to genetic counselling and testing; and (4) obligations regarding the handling of genetic information. Audience members emphasized public education and access to information regarding potential choices, which was different from the emphasis on informed consent and other ethical issues prominent in the literature. Members of the general public emphasized ethical issues that were different than those identified by experts and patients. It is essential that members of the public be included in complex and controversial public policy decisions. (shrink)

The Institute of Medicine's report, the American Medical Association's project, the Open Society Institute's and the initiative sponsored by the Robert Wood Johnson Foundation have focused attention on improving the care of dying patients. These efforts include advance care planning and the use of written advance directives. Although previous studies have provided quantitative descriptions of patient preferences for life-sustaining treatment, including those documented in written ADs, to our knowledge open-ended written preferences have not been studied. Studies of these open-ended preferences (...) could highlight issues with respect to quality end-of-life care. The purpose of this study was to explore the open-ended proxy, health, and personal care preferences of people with HIV as expressed in a written AD form. (shrink)

Background The recent proliferation of health care report cards, especially in cardiac care, has occurred in the absence of an ethical framework to guide in their development and implementation. An ethical framework is a consistent and comprehensive theoretical foundation in ethics, and is formed by integrating ethical theories, relevant literature, and other critical information (such as the views of stakeholders). An ethical framework in the context of cardiac care provides guidance for developing cardiac report cards (CRCs) that are relevant and (...) legitimate to all stakeholders. The purpose of this study is to develop an ethical framework for CRCs. Methods Delphi technique – 13 panelists: 2 administrators, 2 cardiac nurses, 5 cardiac patients, 2 cardiologists, 1 member of the media, and 1 outcomes researcher. Panelists' views regarding the ethics of CRCs were analyzed and organized into themes. Results We have organized panelists' views into ten principles that emerged from the data: 1) improving quality of care, 2) informed understanding, 3) public accountability, 4) transparency, 5) equity, 6) access to information 7) quality of information, 8) multi-stakeholder collaboration, 9) legitimacy, and 10) evaluation and continuous quality improvement. Conclusion We have developed a framework to guide the development and dissemination of CRCs. This ethical framework can provide necessary guidance for those generating CRCs and may help them avoid a number of difficult issues associated with existing ones. (shrink)

Priority setting remains a big challenge for health managers and planners, yet there is paucity of literature on evaluating priority setting. The purpose of this paper is to present a framework for evaluating priority setting in low and middle income countries. We conducted a qualitative study involving a review of literature and Delphi interviews with respondents knowledgeable of priority setting in low and middle income countries. Respondents were asked to identify the measures of successful priority setting in low and middle (...) income countries. Responses were grouped as: immediate internal or external/delayed internal or external. We also identified some pre-requisites for successful priority setting. The immediate internal measures included increased efficiency in decision making, improved quality of decisions and fairer priority setting. Immediate External measures included—improved public understanding and acceptance of decisions, increased public participation, increased trust. Delayed Internal measures included increased satisfaction, understanding, compliance, balanced budget, achievement of organization goals, and improved internal accountability. Delayed External measures include impact on policy and practice, improved population health and reduction of health inequalities, achievement of health system goals and strengthening of health care systems. Identified pre-requisites for successful priority setting included; the presence of credible priority setting institutions, incentives for participation and implementation and resources, capacity and political will to implement. These would be augmented in a conducive political, social and economic context. This framework, although not exhaustive, provides a practical basis for planning and evaluating priority setting in low and middle income countries. (shrink)