Describing practices of priority setting in publicly funded health care systems of high-income countries

Spending in health care have grown considerably over the last decades in all developed countries. Aging populations and novel technologies are usually deemed as the main drivers for such unsustainable trend in the finances of health systems. In this scenario, setting priorities for investments becomes a central concern. Making hard choices in a rational, evidence-informed, systematic, transparent, legitimate, and fair manner has constituted an increasingly important target. Notwithstanding the voluminous body of literature in this area, most of work focus on developing and improving prescriptive approaches as well as presenting case studies. The present work aimed to describe existing practices of priority setting and resource allocation within the context of publicly funded health care systems of high-income countries. An online qualitative survey was used with decision makers and academics from 18 countries. Four hundred and fifty individuals were invited and 58 answered the survey questionnaire. We found that resource allocation in health care has been still largely done based on historical patterns and through ad hoc decisions, despite the wide understanding that decisions must be formally based on multiple explicit criteria. Health technology assessment (HTA) was the tool most commonly indicated by participants as a formal strategy of priority setting. Several approaches have been tested and published, with special emphasis on Program Budgeting and Marginal Analysis (PBMA), but there is limited evidence of their continuous and systematic use by health organizations across countries. A point of increasing convergence is the reliance of multiple types of evidence to judge the value of investment options. Disinvestment frameworks are very rare and the topic itself has only started to appear with any regularity. This work represents the first attempt to identify existing practices of priority setting in a systematic way through a qualitative descriptive study. Despite its methodological limitations, it provides a better understanding of the current scenario of policy making and research in this field.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat