Scientific unknown-base in medical field: Supporting problem-oriented priority setting in basic research / 中华医学科研管理杂志

Objective:The present study delves into the realm of scientific unknowns, which serve as the primary representation of major scientific challenges and often give rise to subversive, non-consensus, and high-risk scientific problems. Addressing this pivotal aspect, we focus on the development of scientific unknown identification methods and tool platforms to provide essential data support for priority setting of basic research through a problem-oriented approach. Such efforts are imperative for managing the scientific and technological innovation system within the context of demands and problem-solving.Methods:While numerous knowledge bases have been established in the medical field, there remains a notable lack of focus on the unknown base. The paper synthesizes relevant literature and existing research, amalgamating the methodological paradigm of scientific big data research with text mining. This integration facilitates comprehensive interpretations and enlightening insights concerning the concept, identification methods, and construction of an unknown-base.Results:By systematically analyzing the concept of scientific unknowns, we present a recognition method based on cognitive state and logical rules. Furthermore, we discuss a classification framework and realization path for scientific unknowns from the dimensions of attribute, relationship, and disease, thereby providing foundational insights for the construction of a medical unknown database.Conclusions:Notably, the research on unknowns in medical science transcends disciplinary boundaries, encompassing the confluence of information science, data science, medical informatics, and science and technology management. As such, this paper seeks to expound upon the significance and application scenarios of unknown research in science, furnishing valuable ideas and references for scholars in the field.

Introduction to Health Research Priority Setting Methods and Application Recommendations of Methods in Field of Traditional Chinese Medicine / 中国实验方剂学杂志

Health research priority setting， based on the existing disease burden or healthcare needs， screens out specific areas or topics with relatively high research priority by scientific and systematic methods， and optimizes the allocation of health resources by influencing healthcare decision-making， so as to alleviate the imbalance between regional or global health and development. Many developed countries have carried out related research and practical work on different scales， and the World Health Organization （WHO） attaches great importance to the transformation and application of relevant achievements in developing countries. As the largest developing country in the world， China's research in this field started relatively late， and only a small number of scholars have carried out part of the localization methodology research and practice according to the specific national conditions. However， health research priority setting has not yet attracted the attention of large-scale research institutions or government organizations in China. Although the priority setting is rarely mentioned in the research on traditional Chinese medicine （TCM）， the research and decision-making on the diseases responding specifically to TCM can also be regarded as the practical work of exploring the priority of TCM. Policymakers have a sense of priority support in the "priority of TCM research"， but the decisions from the top design are mainly based on the consensus reached by high-level think tanks. There is a lack of extensive research， and moreover， the data of multiple stakeholders are not included. Therefore， it is urgent to introduce appropriate priority setting methods to solve the problem of transparency and scientificity in the decision-making process. Given the perspective of the specific implementation， the present study introduced three international priority setting methods， i.e.， the James Lind Alliance and Priority Setting Partnerships（JLAPSP，）the Child Health and Nutrition Research Initiative（CHNRI）， and the Council on Health Research and Development （COHRED）， and presented relevant recommendations on how to apply them in the research of TCM， which is expected to provide references for the local research.

Applying knowledge management in generating and using evidence in health research priority setting (HRPS)

@#<p><strong>BACKGROUND:</strong> Current international recommendations in generating and using evidence in Health Research Priority Setting (HRPS) include the use of systematic reviews, and systematic or scientific situational analysis. In the Philippines, the Philippine National Health Research System's (PNHRS) National Guidelines for Health Research Prioritization recommends the use of either a Combined Approach Matrix (CAM) or situational analysis in generating and using evidence for HRPS. At present, there is a lack of a gold standard in generating and utilizing evidence in HRPS.</p><p><strong>OBJECTIVE: </strong>The primary objective of this paper is to document a practical yet alternative/innovative approach on how evidence was generated and utilized in the process of HRPS as observed in the development of the National Unified Health Research Agenda (NUHRA) in the Philippines. Specifically, it identifies the types of knowledge products produced and their role in the process of health research agenda setting; how evidence was used and managed in the course of NUHRA development; and, the lessons learned from the experience.</p><p><strong>METHODS:</strong> This case study is descriptive of the experience of generating and utilizing evidence for HRPS in the Philippines. The study utilized primary and secondary data. Knowledge Management (KM) was used as a lens to describe the process of generating and managing information for the NUHRA. Document analysis was used in comparing and aligning data with the integrated KM framework.</p><p><strong>RESULTS:</strong> Pre-selected data were captured and created; shared and disseminated; and subsequently acquired and applied voluntarily by stakeholders during the process of HRPS. Relevant data was presented into various information products designed with a specific stakeholder in mind. Technical papers were developed to cater to national level stakeholders and focused on broad, nationally-relevant issues. Regional situational analysis reports focused on regional and local data and were designed for regional stakeholders to use during the development of Regional Unified Health Research Agenda (RUHRA). Infographics were developed to present the findings of the technical papers creatively and concisely and the NUHRA methodology and were presented to both national and regional stakeholders. The RUHRAs and the NUHRA were the outputs of the health research prioritization activities and will be made available through local and national channels of the PNHRS.</p><p><strong>RECOMMENDATIONS:</strong> Opportunities for formalization and institutionalization of knowledge management for generating and using evidence in HRPS may be explored to address health information fragmentation across the health research system.</p>

Accountability for Reasonableness, for Priority Setting and Resource Allocation: A Case Scenario.

ABSTRACT: The purpose of this paper is to discuss the accountability for reasonableness and its four conditions. This explains the priority setting and resource allocation for scarce resources. In this article it is discussed that how the scarce resources in a developing country like Pakistan be allocated in health care. This is explained with the help of case scenario.

Future directions of chronic disease management in South Korea

In Korea, the proportion of medical costs due to chronic diseases among total health care expenditures is increasing rapidly. This trend calls for immediate countermeasures. In the major developed countries in Europe, a gatekeeper system has been adopted at the national level as a universal policy to manage and prevent chronic disease. In South Korea, insurers and local governments offer management programs to individuals with chronic disease and metabolic syndrome under the Korean government's Health Plan 2020, but these programs are fragmented and there are some related limitations. The role of the national government is very important to overcome this problem because the chronic disease management systems of other players (insurers, local governments) must be integrated. In addition, the expert patients program, which is intended to improve the self-care skills of chronic disease patients, needs to be better promoted. Incentives should include "mileage programs" in which patients can accumulate points for successful self-care. It is also important to increase public awareness through large-scale promotional campaigns. Finally, it is necessary to raise funds to conduct national-level campaigns and provide incentives to patients, and to ensure that all processes establish an organic cooperation system. Such practices will maximize the positive effects of a nationwide chronic disease management system in South Korea.

El ámbito de la evaluación económica de intervenciones de salud / The scope of economic evaluation of healthcare interventions

The World Health Organization (WHO) has contributed to the conceptualization of a Health System stating that it has three main objectives and four functions. The main objective is Health Status, measured in Disability Adjusted Life Expectancy (DALE).The others two are Responsiveness to the people’s Non-Medical Expectations and Equity in Financing. This last is a specific indicator of economic nature. Economics has an increasing role in the health systems and the recognition of this component by actors in health services is more and more important every day. Medical professionals need to understand its meaning and relevance in many senses of medical care. Economic evaluations, mainly cost-effectiveness of health programs and socio-sanitary interventions are more complex to carry out than common social evaluations, whose context is more restricted.When formulating modern health policies, the declared objective is always the improvement and quality of healthcare. Nevertheless, in recent years policy makers have insisted in the need to secure economic rationality of interventions, both inside the program, thus achieving internal technical efficiency, as towards the whole society achieving allocative efficiency. When the purpose is to evaluate health programs, economic evaluation integrates costs with effectiveness and considers the epidemiologic profle and social preferences. The priority setting included in the Health Guarantees Plan (AUGE or GES) established by the Chilean Ministry of Health in 2005 is a clear example of a process of Health Technology Assessment , where cost-effectiveness studies were used to set the program and establish priorities. This is the frst in a series of papers related to economic evaluation of healthcare in-terventions. This paper aims to contribute to the development of this feld, providing basic concepts and its main applications to health care in Chile.

La Organización Mundial de la Salud (OMS) ha contribuido a la conceptualiza-ción de lo que es un sistema de salud, en el cual integra tres objetivos y cuatro funciones. El objetivo principal es la salud, la cual es medida con el indicador Expectativa de Vida Ajustada por Discapacidad (EVAD), los otros dos son Capacidad de Respuesta a las Expectativas No Medicas y la Equidad o Justicia Financiera. Esta última es una condición explícita de carácter económico. La economía tiene un papel creciente en los sistemas de salud y es importante que los actores principales del sistema, los profesionales médicos, estén al tanto de ello y logren comprender su dimensión. Las evaluaciones económicas, principalmente las de costo-efectividad de los programas de salud e intervenciones socio-sanitarias siguen siendo más complejas de realizar que las evaluaciones en otras áreas sociales, cuyo contexto es más restringido o específico. En la formulación de políticas de salud modernas, el objetivo declarado es siempre el de mejorar la calidad de los cuidados y de la atención médica. Sin embargo, ahora se hace insistiendo en que uno de los componentes esenciales de la calidad es la racionalidad económica de las intervenciones, tanto internas al propio programa, logrando eficiencia técnica, como al conjunto de la sociedad logrando eficiencia distributiva. Cuando se trata de evaluar Tecnologías Sanitarias, uno de sus componentes es la evaluación económica que integra costos con efectividad clínica y considera el perfilepidemiológico y las preferencias sociales. Estás últimas se pueden incorporar a través de la valoración de los estados de salud (en “outcomes” como Quality-Adjusted Life-Years -QALY) y en el uso de una tasa de descuento social. La determinación de las condiciones de salud incluidas en el Plan de Garantías en Salud (AUGE o GES) es un ejemplo de un proceso de Evaluación de Tecnologías Sanitarias (ETESA). En dicho proceso se hizo una aproximación a incluir explícitamente la evaluación económica, a través de los estudios de costo-efectividad, en la priorización para determinar las condiciones de salud que se integrarían al plan. Este es el primero de una serie de artículos sobre el ámbito de la evaluación económica de intervenciones de salud la que pretende entregar a la comunidad médica un conjunto de contenidos que dan luces sobre el desarrollo de la disciplina y sus conceptos principales, a la vez que sus aplicaciones posibles a las actividades de la salud en nuestro país.

Inequitable distribution of health resources in Brazil: an analysis of national priority setting / Distribución injusta de los recursos en salud en Brasil: un análisis del establecimiento de prioridades nacionales / Distribuição injusta dos recursos em saúde no Brasil: uma análise da definição de prioridades nacionais

The purpose of this paper is to describe the national priority setting process for the public health system in Brazil, evaluating the process using the ethical framework Accountability for Reasonableness, and equity considerations highlighted in the 2008 WHO Commission on Social Determinants of Health. We searched the Brazilian Ministry of Health website for documents that described priority setting within the Brazilian Universal Health Care System (SUS). The National Health Conference (CNS) has been defined by the Ministry of Health as the democratic priority setting forum for SUS. The most recent such conference (13th CNS, 2007) is the subject of this paper. Our analysis suggests that the process of priority setting within SUS has not yet achieved the ethical standards of legitimacy and fairness, and that inequitable distribution of decision making power under- represents users in poor areas. The unmet need for hospital care for children in Brazil, which reflects a remarkable inequality of opportunity for human development, may be a product of poor priority setting processes and inequity in representation.

Este artículo pretende describir el establecimiento de prioridades nacionales en el proceso de cuidado del sistema de salud en Brasil, evaluando el proceso con el empleo del marco ético de Administración Razonable, y de consideraciones de equidad destacadas por la Comisión sobre Determinantes Sociales de la Salud de la Organización Mundial de la Salud (OMS). Buscamos documentos que describieran el establecimiento de prioridades dentro del Sistema Único de Salud brasileño (SUS) en el sitio del Ministerio de Salud Brasileño. La Conferencia Nacional sobre Salud (CNS) ha sido definida por el Ministerio de Salud como el foro del SUS para el establecimiento de prioridades democráticas. La 13¬ CNS, 2007 -la más reciente de dichas conferencias- constituye el tema de este artículo. Nuestro análisis sugiere que el proceso de establecimiento de prioridades dentro del SUS no ha alcanzado aún los patrones éticos de legitimidad y justicia, y que la distribución injusta de las instancias de poder de decisión no representa realmente a las áreas más pobres. La meta aún no alcanzada de necesidad de hospitales para niños en Brasil significa una notable falta de igualdad en las oportunidades para el desarrollo humano y puede que sea producto de la mala definición del proceso de prioridades y de la falta de equidad en la representación.

Este artigo pretende descrever a definição de prioridades nacionais no processo de cuidado do sistema de saúde no Brasil, avaliando o processo com o emprego do marco ético de Administração Razoável e de considerações sobre a equidade, destacadas pela Comissão sobre Determinantes Sociais da Saúde da Organização Mundial da Saúde (OMS). Buscamos documentos que descreveram o estabelecimento de prioridades dentro do Sistema Único de Saúde brasileiro (SUS) no site do Ministério da Saúde brasileiro na web. A Conferência Nacional de Saúde (CNS) foi definida pelo Ministério da Saúde como o fórum do SUS para o estabelecimento de prioridades democráticas. A 13a CNS, 2007 -a mais recente das citadas conferências- constitui o tema deste artigo. Nossa análise sugere que o processo de estabelecimento de prioridades dentro do SUS não alcançou ainda os padrões éticos de legitimidade e justiça e que a distribuição injusta das instâncias do poder de decisão não alcança realmente as áreas mais pobres. A meta ainda não alcançada da necessidade de hospitais infantis no Brasil, o que significa uma notável falta de igualdade de oportunidades para o desenvolvimento humano e pode ser produto de uma má definição do processo de prioridades e da falta de equidade na representação.

Priority setting in an acute care hospital in Argentina: a qualitative case study / Distribución prioritaria en un hospital de cuidados intensivos en Argentina: estudio cualitativo de un caso / Distribuição prioritária em um hospital de cuidados intensivos na Argentina: estudo qualitativo de um caso

Purpose: To describe and evaluate priority setting in an Acute Care hospital in Argentina, using Accountability for Reasonableness, an ethical framework for fair priority setting. Methods: Case Study involving key informant interviews and document review. Thirty respondents were identified using a snowball sampling strategy. A modified thematic approach was used in analyzing the data. Results: Priorities are primarily determined at the Department of Health. The committee which is supposed to set priorities within the hospital was thought not to have much influence. Decisions were based on government policies and objectives, personal relationships, economic, political, historical and arbitrary reasons. Decisions at the DOH were publicized through internet; however, apart from the tenders and a general budget, details of hospital decisions were not publicized. CATA provided an accessible but ineffective forum for appeals. There were no clear mechanisms for appeals and leadership to ensure adherence to a fair process. Conclusions: In spite of their efforts to ensure fairness, Priority setting in the study hospital did not meet all the four conditions of a fair process. Policy discussions on improving legitimacy and fairness provided an opportunity for improving fairness in the hospital and Accountability for Reasonableness might be a useful framework for analysis and for identifying and improving strategies.

Propósito: Describir y evaluar el establecimiento de prioridades en un hospital de cuidados intensivos en Argentina, empleando la Administración Razonable como marco ético para una justa asignación. Métodos: Estudio de un Caso que incluía entrevistas a un informante y revisión de documentos. Se identificó a treinta participantes empleando la estrategia de muestras tipo "bola de nieve". Al analizar los datos, se empleó un enfoque temático modificado. Resultados: Las prioridades se determinan principalmente en el Departamento de Salud. El comité que, se supone, debe establecer las prioridades dentro del hospital no tiene mayor influencia. Las decisiones se basan en políticas y objetivos gubernamentales, relaciones personales, razones económicas, políticas, históricas e, incluso, arbitrarias. Las decisiones del Departamento de Salud se publicitan a través de Internet; sin embargo, fuera de las propuestas y del presupuesto general, no se publicitan las decisiones del hospital. CATA proporciona un foro accesible pero ineficaz para apelar. No existen mecanismos claros para apelar ni para un liderazgo que asegure un proceso justo. Conclusiones: A pesar de los esfuerzos por asegurar la equidad, el establecimiento de prioridades del hospital no cumple las cuatro condiciones de un proceso justo. Las discusiones acerca de políticas de mejoramiento, legitimidad y equidad dan oportunidad para mejorar la equidad en el hospital, y el marco ético "Administración Razonable" podría constituir un marco útil para el análisis así como para identificar y mejorar las estrategias.

Propósito: Descrever e avaliar o estabelecimento de prioridades em um hospital de cuidados intensivos na Argentina, empregando a Administração Razoável como marco ético para uma justa destinação de recursos. Métodos: Estudo de um caso que incluía entrevistas a um informante e revisão de documentos. Foram identificados trinta participantes empregando a estratégia de amostras tipo bola de neve. Ao analisar os dados, se empregou um enfoque temático modificado. Resultados: As prioridades são determinadas principalmente no Departamento de Saúde. O comitê que, se supõe, deve estabelecer as prioridades dentro do hospital não tem maior influência. As decisões se baseiam em políticas e objetivos governamentais, relações pessoais, razões econômicas, políticas, históricas e, inclusive, arbitrárias. As decisões do Departamento de Saúde são divulgadas por meio da Internet; no entanto, além das propostas e do orçamento geral, não se divulgam as decisões do hospital. CATA proporciona uma instância acessível, porém ineficaz para apelar. Não existem mecanismos claros para apelar nem para uma liderança que assegure um processo justo. Conclusões: Apesar dos esforços para assegurar a equidade, o estabelecimento de prioridades do hospital não cumpre as quatro condições de um processo justo. As discussões sobre políticas de melhoria, legitimidade e equidade dão oportunidade para melhorar a equidade no hospital e no marco ético "Administração Razoável" poderia constituir um marco útil para a análise assim como para identificar e melhorar as estratégias.

Hospital priority setting in a mixed public/private health system: a case study of a Chilean hospital / Establecimiento de prioridades en un sistema de salud mixto público/privado: estudio de caso en un hospital chileno / Estabelecimento de prioridades em um sistema de saúde misto público/privado: estudo de caso em hospital chileno

The purpose of this study was to describe, using qualitative case study methods, and evaluate, using the ethical framework 'accountability for reasonableness', priority setting in a hospital in Chile. In policy making contexts that have historically been dominated by central authority, especially where there are limited resources, fair priority setting processes can empower people, foster social learning, improve the quality of the decisions, enhance compliance with policy decisions, and increase public confidence in the hospital.

El propósito de este estudio fue describir, a través del uso de métodos cualitativos en un estudio de caso, y evaluar, siguiendo la estructura ética de "Administración Razonable", el proceso de priorización en salud en un hospital de Chile. En el contexto de las políticas públicas ha dominado históricamente la centralización de la autoridad, especialmente cuando los recursos son limitados. Un proceso justo de priorización en salud puede empoderar a las personas, mejorar y aumentar el proceso de aprendizaje social, mejorar la calidad de las decisiones, aumentar el grado de adherencia y satisfacción de las políticas desarrolladas y aumentar la confianza pública en el hospital.

O propósito deste estudo foi descrever, por métodos qualitativos em um estudo de caso, e avaliar, seguindo a estrutura ética de "administração razoável", o processo de priorização em saúde em um hospital chileno. No contexto das políticas públicas onde tem dominado historicamente a centralização da autoridade, especialmente quando os recursos são limitados, um processo justo de priorização em saúde pode empoderar as pessoas, melhorar e aumentar o processo de aprendizagem social, melhorar a qualidade das decisões, aumentar o grau de aderência e satisfação das políticas desenvolvidas e a confiança pública no hospital.

Directing Diarrhoeal Disease Research towards Disease-burden Reduction.

Despite gains in controlling mortality relating to diarrhoeal disease, the burden of disease remains unacceptably high. To refocus health research to target disease-burden reduction as the goal of research in child health, the Child Health and Nutrition Research Initiative developed a systematic strategy to rank health research options. This priority-setting exercise included listing of 46 competitive research options in diarrhoeal disease and their critical and quantitative appraisal by 10 experts based on five criteria for research that reflect the ability of the research to be translated into interventions and achieved disease-burden reduction. These criteria included the answerability of the research questions; the efficacy and effectiveness of the intervention resulting from the research; the maximal potential for disease-burden reduction of the interventions derived from the research; the affordability, deliverability, and sustainability of the intervention supported by the research; and the overall effect of the research-derived intervention on equity. Experts scored each research option independently to delineate the best investments for diarrhoeal disease control in the developing world to reduce the burden of disease by 2015. Priority scores obtained for health policy and systems research obtained eight of the top 10 rankings in overall scores, indicating that current investments in health research are significantly different from those estimated to be the most effective in reducing the global burden of diarrhoeal disease by 2015.

Setting research priorities by applying the combined approach matrix.

Background & objectives: Priority setting in health research is a dynamic process. Different organizations and institutes have been working in the field of research priority setting for many years. In 1999 the Global Forum for Health Research presented a research priority setting tool called the Combined Approach Matrix or CAM. Since its development, the CAM has been successfully applied to set research priorities for diseases, conditions and programmes at global, regional and national levels. This paper briefly explains the CAM methodology and how it could be applied in different settings, giving examples and describing challenges encountered in the process of setting research priorities and providing recommendations for further work in this field. Methods: The construct and design of the CAM is explained along with different steps needed, including planning and organization of a priority-setting exercise and how it could be applied in different settings. Results: The application of the CAM are described by using three examples. The first concerns setting research priorities for a global programme, the second describes application at the country level and the third setting research priorities for diseases. Interpretation & conclusions: Effective application of the CAM in different and diverse environments proves its utility as a tool for setting research priorities. Potential challenges encountered in the process of research priority setting are discussed and some recommendations for further work in this field are provided.

Evaluación del proceso de priorización en salud en Colombia: perspectiva de grupos de investigación ubicados en Bogotá / Evaluating how health is prioritised in Colombia from the point of view of Bogotá-based research groups

Objetivo Evaluar el proceso de priorización de investigaciones en salud llevado a cabo en el país a partir de las metodologías internacionales y desde la perspectiva de los grupos de investigación en salud, categoría A, ubicados en Bogotá. Métodos: A partir de un enfoque cualitativo, se realizaron 14 entrevistas semies­tructuradas a líderes de los grupos seleccionados a través de una muestra propositiva. Con el programa de análisis de información cualitativa Atlas Ti se generaron categorías para comparación. Resultados Cada grupo posee diferentes experiencias en investigación en el campo de la salud. Algunos manifestaron sus propias concepciones sobre la salud y sobre la priorización a partir de sus marcos epistemológicos. Diferentes líderes de los grupos expresaron que hay una fuerte orientación biomédica en los procesos de priorización y de las metodologías utilizadas para tal fin. Un número importante de ellos ha reconocido la importancia de la participación de otros actores sociales en la definición de las prioridades para la investigación en salud, además de los mismos investigadores, dentro de un escenario de dialogo y de concertación. Por último, los líderes entrevistados plantearon algunos cuestionamientos frente a la definición de prioridades y sugirieron la importancia de fomentar un proceso más participativo e incluyente comenzando por los mismos investigadores en salud. Discusión Los hallazgos muestran la enorme heterogeneidad de posiciones frente a la temática de la priorización de investigaciones en salud y las dificultades para alcanzar consensos entre los mismos investigadores.

Objective Assessing how priorities are established in Colombia in line with international methodologies and from the perspective of Bogotá-based Category A health research groups. Methods This study used a qualitative approach; 14 leaders from groups selected via a propositive sample were given semi-structured interviews to obtain a compre­hensive interpretation of priority-setting in Colombia. ATLAS Ti software was used for organising information and producing categories from transcripts. Results Each group had a different research background and came from health research areas such as basic science, clinical science and the wide field of public health. Some talked about their own definitions of health and establishing priorities as related to their own epistemological frameworks. Other leaders stressed that a bio­medical approach still predominated in health research, priority-setting and the inter­national methodologies used for such end. Many recognised the importance of differ­ent social actors (i.e. apart from researchers) becoming involved in defining health research priorities within a scenario emphasising dialogue and coming to agreement. The leaders criticised the national health science and technology system raising questions regarding defining priorities; they stated that dialogue and involvement must be promoted. Discussion These findings revealed enormous heterogeneity regarding prioritising health research as every researcher has a different point of view due to their experi­ence and backgrounds and the difficulties in researchers' reaching consensus.

A Study on Characteristics of Core Projects Described in 3rd Community Health Plans / 예방의학회지

OBJECTIVE: The 3rd community health plan let health centers select and promote core projects considering budget and manpower. This study analyzed the content and selection processes of core projects, using the nationwide 3rd community health plans, to give relevant information on health center policies. METHODS: Classification criteria for content analysis of core projects were established and verified through a literature review and by specialist discussions. Fifty plans were selected by stratified proportional random sampling for regional characteristics. And coding criteria standardized through coding repetition and discussion, by 2 persons (k> 0.7). Using stratified proportional random sampling for 16 cities and provinces, regional characteristics, 117 plans were selected, and the contents of the core project selection processes and program contents analyzed. RESULTS: The survey was used by 59.8 % of samples as a core project decision-making method. The participants included 98.6, 81.4, 40 and 38.6% of the health staffs, residents, medical institutions, and administrators, respectively. Discussion was used by 15.4% of samples. The participants were health staffs by 100% as a great. The ranking of the frequencies of the selected core projects were, in order; chronic disease control, health promotion, elderly health, maternal-child health, and oral health at 16.4, 14.8, 14.3, 12.7 and 11.9%, respectively. Analyses on the chronic disease control and elderly health contents showed the diversity of object disease, high rates of visitors on patient detection programs, high rates of unclear target populations, and the provision of medical exams and treatments as the main services, with high variations in business per-formance. The national health budgets for health centers in 2003 were about 910 and 240 million won for chronic disease control and elderly health, respectively, which were less than for the other five priority core projects. CONCLUSION: The chronic disease control and elderly health at the health centers were not standardized for object disease, patient detection program, target population, service provision, and national support budget was insufficient. Thus it is necessary to develop standard guidelines, and increase financial support, for chronic disease control and elderly health.