Explicit Priority Setting Approaches in Health Care Coverage Policies: A Critical Review and Implications for Further Research

Background: Several explicit approaches are used to make decision on health services coverage and to develop the basic health package. In this study, first the approaches used to prioritize health services were introduced, and then the limitations of each method were reported. Methods: We critically reviewed market literature regarding explicit priority setting approaches. The current literature focusing on explicit priority setting approaches in health care system was reviewed. Results: Eight explicit approaches for prioritizing health care were identified: CEA, CEA / BOD, PBMA, HTA, MCDA, A4R, the Value Assessment Framework, and combinational approaches such as MCDA-A4R and PBMA-A4R. Developing the value framework for making a decision, not just informing a decision was needed to be investigated. Conclusion: This study addressed the explicit health services prioritization methods. The results showed that a value framework approach as one of the innovative approaches that has become increasingly widespread in recent years can help to achieve goals of the health system.

Keywords:

Coverage Decision Making , Critical Review , Evidence-Informed Deliberative Process , Priority Setting , Value Framework