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The greatest happiness of the greatest number? Policy actors' perspectives on the limits of economic evaluation as a tool for informing health care coverage decisions in Thailand.

ABSTRACT: BACKGROUND: This paper presents qualitative findings from an assessment of the acceptability of using economic evaluation among policy actors in Thailand. Using cost-utility data from two economic analyses a hypothetical case scenario was created in which policy actors had to choose between two competing interventions to include in a public health benefit package. The two competing interventions, laparoscopic cholecystectomy (LC) for gallbladder disease versus renal dialysis for chronic renal disease, were selected because they highlighted conflicting criteria influencing the allocation of healthcare resources. METHODS: Semi-structured interviews were conducted with 36 policy actors who play a major role in resource allocation decisions within the Thai healthcare system. These included 14 policy makers at the national level, five hospital directors, ten health professionals and seven academics. RESULTS: Twenty six out of 36 (72%) respondents were not convinced by the presentation of economic evaluation findings and chose not to support the inclusion of a proven cost-effective intervention (LC) in the benefit package due to ethical, institutional and political considerations. There were only six respondents, including three policy makers at national level, one hospital director, one health professional and one academic, (6/36, 17%) whose decisions were influenced by economic evaluation evidence. CONCLUSION: This paper illustrates limitations of using economic evaluation information in decision making priorities of health care, perceived by different policy actors. It demonstrates that the concept of maximising health utility fails to recognise other important societal values in making health resource allocation decisions.

SUBMITTER: Teerawattananon Y

PROVIDER: S-EPMC2569929 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundPositive psychological interventions for children have typically focused on direct adaptations of interventions developed for adults. As the community moves toward designing positive computing technologies to support child well-being, it is important to use a more participatory process that directly engages children's voices.ObjectiveOur objectives were, through a participatory design study, to understand children's interpretations of positive psychology concepts, as well as their perspectives on technologies that are best suited to enhance their engagement with practice of well-being skills.MethodsWe addressed these questions through a content analysis of 434 design ideas, 51 sketches, and 8 prototype and videos, which emerged from a 14-session cooperative inquiry study with 12 child "happiness inventors." The study was part of a summer learning camp held at the children's middle school, which focused on teaching the invention process, teaching well-being skills drawn from positive psychology and related areas (gratitude, mindfulness, and problem solving), and iterating design ideas for technologies to support these skills.ResultsThe children's ideas and prototypes revealed specific facets of how they interpreted gratitude (as thanking, being positive, and doing good things), mindfulness (as externally representing thought and emotions, controlling those thoughts and emotions, getting through unpleasant things, and avoiding forgetting something), and problem solving (as preventing bad decisions, seeking alternative solutions, and not dwelling on unproductive thoughts). This process also revealed that children emphasized particular technologies in their solutions. While desktop or laptop solutions were notably lacking, other ideas were roughly evenly distributed between mobile apps and embodied computing technologies (toys, wearables, etc). We also report on desired functionalities and approaches to engagement in the children's ideas, such as a notable emphasis on representing and responding to internal states.ConclusionsOur findings point to promising directions for the design of positive computing technologies targeted at children, with particular emphases on the perspectives, technologies, engagement approaches, and functionalities that appealed to the children in our study. The dual focus of the study on teaching skills while designing technologies is a novel methodology in the design of positive computing technologies intended to increase child well-being.

Project description:BackgroundCanadians have long been proud of their universal health insurance system, which publicly funds the cost of physician visits and hospitalizations at the point of care. Prescription drugs however, have been subject to a patchwork of public and private coverage which is frequently inefficient and creates access barriers to necessary medicine for many Canadians.MethodsA narrative review was undertaken to understand the important economic, policy and political considerations regarding implementation of universal prescription drug access in Canada (pan-Canadian pharmacare). PubMed, SCOPUS and google scholar were searched for relevant citations. Citation trails were followed for additional information sources. Published books, public reports, press releases, policy papers, government webpages and other forms of gray literature were collected from iterative internet searches to provide a complete view of the current state on this topic.Main findingsRegarding health economics, all five of the reviewed pharmacare simulation models have shown reductions in annual prescription drug expenditure. However, differing policy and cost assumptions have resulted in a wide range of cost-saving estimates between models. In terms of policy, a single-payer, 'first-dollar' coverage model, using a minimum national formulary, is the model most frequently advocated by the academic community, healthcare professions and many public and patient groups. In contrast, a multi-payer, catastrophic 'last-dollar' coverage model, more similar to the current "patchwork" state of public and private coverage, is preferred by industry drug manufacturers and private health insurance companies. Primary concerns from the detractors of universal, single-payer, 'first-dollar' coverage are the financing required for its implementation and the access barriers that may be created for certain patient populations that are not majorly present in the current public-private payer mix.ConclusionCanada patiently awaits to see how the issue of prescription drug coverage will be resolved through the work of the Advisory Council on the Implementation of National Pharmacare. The overarching and ongoing discourse on policy and program implementation may be construed as a political debate informed by divergent public and private interests.

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The greatest happiness of the greatest number? Policy actors' perspectives on the limits of economic evaluation as a tool for informing health care coverage decisions in Thailand.

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