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.

Avaliação de custo-utilidade como mecanismo de alocação de recursos em saúde: revisão do debate / Cost-utility analysis as a mechanism for allocation of health care resources: a review of the debate

Estabelecer prioridades em saúde traduz-se em escolhas entre programas alternativos e/ou entre pacientes ou grupos de pacientes. Tradicionalmente, os economistas da saúde propuseram a agregação dos ganhos de saúde, avaliados em QALYs, como forma de estabelecer prioridades e maximizar o bem-estar social. Isso requer que o valor social dos ganhos de saúde seja um produto dos ganhos em anos de vida, qualidade de vida e número de pessoas tratadas. Resultados da revisão de literatura sugerem que nem os potenciais ganhos de saúde são, por si só, um determinante significativo de valor nem a regra da maximização dos ganhos de saúde parece suficiente. O valor social de um ganho de saúde parece não ser uma função linear dos ganhos de mortalidade e morbidade, nem parece neutral às características dos doentes ou à distribuição final de saúde entre a população. Paralelamente à revisão do debate sobre o papel e limitação dos QALYs para a priorização dos recursos da saúde, o artigo procura justificar a controvérsia de alguns resultados empíricos, em particular, no que se refere à formação e manifestação das preferências sociais.

Priority setting in health care involves choosing between alternative health care programs and/or patients or groups of patients who will receive care. Traditionally, health economists have proposed maximizing the additional health gain measured in QALYs as a way of setting priorities and maximizing social welfare. This requires that the social value from health improvements be a product of gains in years of life, quality of life, and number of people treated. The results of a literature review suggest that potential health gain is not a single relevant determinant of value, nor is the rule of maximizing this gain sufficient. The social value of a health gain appears not to be linear in terms of mortality and morbidity, or neutral vis-à-vis people's characteristics or the ultimate distribution of health in society. In parallel with the review of the debate on the role and limitation of QALYs for prioritizing health care resources, the article attempts to justify the controversy over some empirical results, particularly in relation to the construction and expression of social preferences.

[Health-sector funding: options for funding health care in Iraq]

One of the basic issues faced by a state is the system of health care delivered to the citizens and method of funding this system. The importance of this issue lies in the fact that an established system of health care reflects the values, social priorities and economic system of such a state. This paper presents the available options for funding the health-care system in Iraq. It is a summary of ideas and views discussed on several occasions between 2004 and 2005, especially at the First National Conference on Health in Iraq, held in Baghdad in August 2004, and the Health-Sector Funding Symposium, organized by the Ministry of Health in Amman, Jordan, in November 2004

Dr. B. C. Dasgupta Memorial Oration. Priorities, issues, inter-state variations and challenges.

India spends only 1.5% of GDP on health as against the recommended 5% by W.H.O. for equity and universal coverage. States have a high share (89%) of funding their health care activities as against 9% by centre and 2.8% by U. T.'s. Increasing proportion of health expenditure on salaries (60-90%) and a markedly reduced (29%-5%) proportion on non-salary components is reflected in low-level of utilization of health services. Committed involvement by others in selected crucial areas is lacking. Health financing seems to be directed towards the urban sector with maximum outlays to curative care. There are high inter-state variations in health expenditure and health status. Higher share of SDF on public health does not guarantee a better health status. Health services sector urgently & legitimately needs additional resources. There is need to set up technical committee and research cells to sensitise policy makers, academicians and others and to steer and guide research. Health Financing and Management must be considered together to address issues of equity, efficiency and effectiveness in health care services.