Model for Value-based Policy-making in Health Systems

Lida Shams, Ali Akbari Sari, Shahram Yazdani, Taha Nasiri

Abstract


Background: Values are at the heart of discussions related to policy-making and any kind of reforms in health systems. Despite wide recognition of its importance, the concept of value is still vague and the policy-making processes remain astray with respect to values. This study aims to provide a model of value-based policy-making and to explain the concept value and how it affects policy-making.

Methods: The main question of the current study is to explain the concept of value-based policy-making and developing a model, based on the explained concept. In this line, critical review method and Carnwell and Daly approach and using particular keywords related to stewardship, and searching databases were used. In the initial search, 739 studies were obtained, of which using targeted sampling method, 11 studies were finally selected. Then, in order to design and explain different aspects of the value concept in the health system and to develop a model, selected studies were criticized, and finally, the conceptual model of value is designed and explained.

Results: The concept of value and its effects, dimensions and its relation to principles, evidence and criteria were determined at different stages of the policy-making process. It was also revealed that value-based policy-making in a health system is contingent upon the realization of terminal values.

Conclusions: In the process of selecting the best policy option, it is necessary to identify the relationship between terminal, instrumental, criterion, and evidence to avoid deviating from the reference value framework in any country and to avoid blindly imitating other experiences in other countries.


Keywords


Ethical theory; health policy; reference values; research evidence

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References


Roberts M, Hsiao W, Berman P, Reich M. Getting Health

Reform Right: A Guide to Improving Performance and Equity.

Oxford University Press; 2008.

Nasiri T, Takian A, Yazdani S. Stewardship in health, designing

a multi-layer meta model: A review article. Iran J Public Health

;48:579-92.

Boffin N. Stewardship of Health Systems: Review of the

Literature. Antwerp: Institute of Tropical Medicine; 2002.

Shams L, Yazdani S, Takian A, Nasiri T. Multi-sectoral

requirements of non-communicable diseases stewardship in Iran.

Revista Publicando 2018;5:1420-37.

Manavi S, Manesh AO, Yazdani S, Shams L, Nasiri T,

Shirvani A, et al. Model for implementing evidence based health

care system in Iran. Iran J Public Health 2013;42:758-66.

Nasrollahpour Shirvani S, Mouodi S. Evidence–Based

Policymaking in Health System and Its Achievements and

Challenge in Iran. Babol: Education Development Center

Publication; 2013.

Organization WH. The World Health Report 2000: Health

Systems: Improving Performance. World Health Organization;

Porche DJ. Health Policy. Jones & Bartlett Learning; 2017.

Schoemaker PJ, Russo JE. A pyramid of decision approaches.

Decision Theory and Decision Analysis: Trends and Challenges.

Springer; 1994. p. 53-78.

CHSR F. Health Services Research and Evidence-based Decision

Making. Canada: Health Services Research and Evidence-based

Decision Making; 2000.

Head B. Evidence-based policy: Principles and requirements.

Strengthening Evid Based Pol Aust Fed 2010;1:13-26.

Green A, Bennett S. Sound choices: Enhancing capacity for

evidence-informed health policy. 2007.

Hunink MM, Weinstein MC, Wittenberg E,

Drummond MF, Pliskin JS, Wong JB, et al. Decision making

in health and medicine: Integrating evidence and values. Cambridge University Press; 2014.

Peile E. Evidence-based medicine and values-based medicine:

Partners in clinical education as well as in clinical practice.

BMC Med 2013;11:40.

Giacomini M, Hurley J, Gold I, Smith P, Abelson J. The policy

analysis of ‘values talk’: Lessons from Canadian health reform.

Health Policy 2004;67:15-24.

Grant MJ, Booth A. A typology of reviews: An analysis of

review types and associated methodologies. Health Inf Libr J

;26:91-108.

Carnwell R, Daly W. Strategies for the construction of a critical

review of the literature. Nurse Educ Pract 2001;1:57-63.

Carnevale F. Authentic qualitative research and the quest for

methodological rigour. Can J Nurs Res 2002;34:121-8.

Shams L, Akbari Sari A, Yazdani S. Values in health policy – A

concept analysis. Int J Health Policy Manag 2016;5:623-30.

Sutcliffe S, Court J. Evidence-based policymaking: What is it?

How does it work? What relevance for developing countries.

Overseas Development Institute; 2005.

Jacobs JA, Jones E, Gabella BA, Spring B, Brownson RC. Peer

reviewed: Tools for implementing an evidence-based approach in

public health practice. Prev Chronic Dis 2012;9:E116.

Satterfield JM, Spring B, Brownson RC, Mullen EJ, Newhouse

RP, Walker BB, et al. Toward a transdisciplinary model of

evidence-based practice. Milbank Q 2009;87:368-90.

Bromell D, editor. Doing the right thing: Ethical dilemmas in

public policy making 2012: Working Paper. Centre for Theology

and Public Issues, in New Zealand ….

Huang R. On the nature of public policy. Chinese Public

Administration Review 2002;1.

Goetghebeur MM, Wagner M, Khoury H, Levitt RJ, Erickson LJ,

Rindress D. Evidence and Value: Impact on DEcisionMaking–

the EVIDEM framework and potential applications. BMC Health

Serv Res 2008;8:270.

Bennett MD, Gibson JM. A Field Guide to Good Decisions:

Values in Action. Greenwood Publishing Group; 2006.

Banks G. Evidence-based policy making: What is it? How do we

get it? How Do We Get It. 2009.

Deth J, Scarbrough E. The Impact of Values: Beliefs in

Government. United Kingdom: Foundation EAS; 1998.

Niemeyer S. Deliberation in the wilderness: Displacing symbolic

politics. Environ Polit 2004;13:347-72.

Stewart J. Public Policy Values. Springer; 2009.

McLaughlin B. Values in behavioral science. J Relig Health

;4:258-79.

Belton V, Stewart T. Multiple Criteria Decision Analysis: An

Integrated Approach. Springer Science & Business Media;

Fulford KW. The value of evidence and evidence of values:

Bringing together values-based and evidence-based practice in

policy and service development in mental health. J Eval Clin

Pract 2011;17:976-87.

Gasparatos A. Embedded value systems in sustainability

assessment tools and their implications. J Environ Manage

;91:1613-22.

Giacomini M, Hurley J, Gold I, Smith P, Abelson J. ‘Values’ In

Canadian Health Policy Analysis: What Are We Talking About?

Canadian Health Services Research Foundation; 2001. p. 13.

Schwartz SH. Universals in the content and structure of values:

Theoretical advances and empirical tests in 20 countries. Adv

Exp Soc Psychol 1992;25:1-65.

Sumaco FT, Imrie BC, Hussain K. The consequence of

Malaysian national culture values on hotel branding. Procedia

Soc Behav Sci 2014;144:91-101.

Giacomini M, Kenny N, DeJean D. Ethics frameworks in

Canadian health policies: Foundation, scaffolding, or window

dressing? Health Policy 2009;89:58-71.

Hoedemaekers R, Dekkers W. Justice and solidarity in priority

setting in health care. Health Care Anal 2003;11:325-43.

Shams L. Development of Value based policy making modeling

for resource allocation in health system of Islamic Republic

of Iran School of Public Health. Tehran University of Medical

Sciences, Tehran, Iran; 2016.

Tetlock PE. A value pluralism model of ideological reasoning. J

Pers Soc Psychol 1986;50:819-34.

Rand A. The Ayn Rand lexicon: Objectivism from A to Z.

Penguin; 1988.

Van Deth JW, Scarbrough E. The Impact of Values. Oxford

University Press; 1998.

De Almeida AT. Additive-veto models for choice and

ranking multicriteria decision problems. Asia Pac J Oper Res

;30:1350026.

Mills AE, Spencer EM, editors. Values based decision making:

A tool for achieving the goals of healthcare. Hec Forum

;17:18-32.

Mccartney JJ, editor. Values based decision making in healthcare:

Introduction. HEC Forum 2005;17:1-5.

Greenhalgh T, Russell J. Evidence-based policymaking: A

critique. Perspect Biol Med 2009;52:304-18.

Hadorn DC. The Oregon priority-setting exercise: Quality of life

and public policy. Hastings Cent Rep 1991;21:S11-6.

Sabik LM, Lie RK. Priority setting in health care: Lessons from

the experiences of eight countries. Int J Equity Health 2008;7:4.

Litvin B. The Problem of Dirty Hands: Can Public Guilt Produce

Public Awareness? 2011.

Clark S, Weale A. Social values in health priority setting: A

conceptual framework. J Health Organ Manag 2012;26:293-316.

Davies P. Is evidence-based government possible. Jerry Lee

Lecture 2004;19.

Priester R. A values framework for health system reform. Health

Affairs 1992;11:84-107.

Khayatzadeh-Mahani A, Fotaki M, Harvey G. Ethical theories

and values in priority setting: A case study of the Iranian health

system. Public Health Ethics 2012;6:60-72.

Bowen S, Zwi AB. Pathways to “evidence-informed” policy and

practice: A framework for action. PLoS Med 2005;2:e166.

Kehoe SM, Ponting JR. Value importance and value congruence

as determinants of trust in health policy actors. Soc Sci Med

;57:1065-75.

Youngkong S, Tromp N, Chitama D. The EVIDEM framework

and its usefulness for priority setting across a broad range of

health interventions. Cost Eff Resour Alloc 2011;9:8.

Strydom WF, Funke N, Nienaber S, Nortje K, Steyn M. Evidencebased policymaking: A review. S Afr J Sci 2010;106:17-24.

Kenny N, Joffres C. An ethical analysis of international health

priority-setting. Health Care Anal 2008;16:145-60.