3.2: Priority Setting in Mexico
Wednesday 29 October 2008, 09:00 - 10:30
Priority-Setting Under Resources Restrictions: Analyzing Preventive Interventions Against Cervical Cancer in Mexico
(Abstract 0054)Cristina Gutierrez-Delgado1, Alejandra Prieto-de la Rosa2, Gisela Morales-Gonzalez3, Dafna Feinholz Klip3
1Economic Analysis Unit, Mexico, 2National Center for Technological Excellence, Mexico, 3National Commission of Bioethics, Mexico
Background: In recent years several new preventive interventions against cervical cancer were developed. Given the importance of this cancer in Mexico and resources restrictions of the public health system a priority setting process is developed.
Objective: To present results of the first priority setting process developed by the Ministry of Health applied to three preventive interventions against cervical cancer (HPV vaccine, Hybrid capture, Papanicolaou) focused on facilitating informed and fair decision making by analyzing financial and nonfinancial considerations.
Methods: From April 2007, a series of studies and discussions are taking place to identify key clinical, financial, operative, ethical and social issues concerning preventive interventions against cervical cancer. The analyses and discussions are conducted by a multidisciplinary group from the Mexican Ministry of Health. Conclusions are presented to decision makers.
Results: Based on available evidence on efficacy, cost, ethical and social implications of interventions analyzed introducing some of them to Mexico’s public health system may have negative unforeseen consequences for participants and poor results in resources allocation.
Policy Implications: Three preventive interventions are examined in the Mexican context, recognizing its risks without overestimating actual or potential results. Scientific evidence regarding interventions, motivations behind particular policy options, potential lives saved using interventions analyzed, respect of rights, opinions and worries of participant women as well as whether interventions provide an added value for Mexican society as a whole are arguments presented to decision makers for them to responsibly arrive at a decision regarding HPV vaccination, cervical cancer screening and treatment programs.
A Health Technology Assessment Agency in the Prioritization Process in Mexico
(Abstract 0154)Adriana Velazquez, Alejandra Prieto
CENETEC , Mexico
The need for Health Technology, assuming drugs, medical devices, clinical procedures and systems, is increasing, now that epidemiological and demographical conditions are changing in developing countries. These situations added to financial constrains, enhance the need for reliable information on clinical, ethical, social and economical implications of the incorporation and use of health technologies. This paper describes the establishment and work of a Health Technology Assessment (HTA) agency in a developing country, to provide information on TS, specifically on medical devices; and its interactions with decision makers that allow to prioritize interventions that would help to achieve the Health Goals in the country.
Presenting Author: Adriana Velazquez-Berumen
25 years experience in Clinical Engineering and Health Technology Management. Consultant to PAHO and WHO for 15 years and member of the board of directors of: IFMBE, INAHTA, CORAL, SOMIB. Founder and director of the National Center for Health Technology Excellence in the Mexican Ministry of Health.
Learning Objectives
Attendants will be able to learn from:
- The experience of building an HTA agency in a developing country.
- The participation of an HTA agency in the prioritization process.
Priority-Setting for Complex Diseases Under Limited Resources: The Case of Mexico’s Catastrophic Expenses Fund
(Abstract 0156)Jaqueline Arzoz, Feinholz Dafna
Universidad Nacional Autónoma de México, Mexico
Background: From February 2006 a project to gradually building a priority-setting methodology for complex diseases to be eventually covered by the limited resources Catastrophic Expenses Fund was developed by the Mexican Ministry of Health towards the General Health Council. The most recent version of the methodology started operations in February 2008.
Objective: Present advances and caveats associated with the definition and application of the priority-setting methodology for complex diseases to be covered by the Catastrophic Expenses Fund.
Methods: Working parties under a fair process perspective are developing a series of studies and discussions to evaluate clinical, economic, ethical and social acceptability criteria inherent to the set of complex diseases identified as candidates for gradual coverage. Quantitative and qualitative methods are used during the evaluation. Results of the methodology will be presented to the Ministry of Health through explicit recommendations to facilitate informed and fair decision-making.
Results: The methodology provides a frame that can be easily applied, reproduced and understood by working-parties and decision-makers. Main caveats associated with the operation of the methodology are the scarcity of data to qualify some of the criteria evaluated as well as the time needed to complete the studies and reaching consensus during discussions.
Policy implications: The priority-setting methodology is providing a degree of transparency and accountability in the decision-making process which is proving useful to guide and mitigate lobbying by third parties as well as for supporting recommendations presented to decision-makers, promoting a sense of fairness and legitimacy.
Translating Ethical Theory into Practice: The Implementation of a Fair Process for Health Priority Setting at the Mexican Ministry of Health
(Abstract 0161)Adriane Gelpi
Harvard University, United States
As the cases presented in this session demonstrate, the Mexican Ministry of Health is in the process of implementing a fair process for priority setting in health care. Priority setting for health resource allocation decisions raises a host of ethical as well as empirical issues. Since no consensus exists about which ethical principles should guide priority-setting decisions in health, a fair process for making such decisions offers the best strategy for insuring the fairness and legitimacy of the final policies. This paper provides an overview of the theoretical foundation of this work, by describing ‘accountability for reasonableness, a theoretical framework that has guided recent work in development of a fair process for priority setting at the Mexican Ministry of Health. According to this framework, developed by Professor Norman Daniels of Harvard University, a decision-making process is accountable for the reasonableness of its decisions when it meets four conditions: relevance, publicity, appeals and enforcement. By concretizing otherwise abstract concepts of fairness and legitimacy, the framework permits empirical evaluation of decision-making processes, which must be designed in an appropriate way given the institutional context.