Technology assessment and resource allocation for predictive genetic testing: A study of the perspectives of Canadian genetic health care providers

<p>Abstract</p> <p>Background</p> <p>With a growing number of genetic tests becoming available to the health and consumer markets, genetic health care providers in Canada are faced with the challenge of developing robust decision rules or guidelines to allocate a finite number of public resources. The objective of this study was to gain Canadian genetic health providers' perspectives on factors and criteria that influence and shape resource allocation decisions for publically funded predictive genetic testing in Canada.</p> <p>Methods</p> <p>The authors conducted semi-structured interviews with 16 senior lab directors and clinicians at publically funded Canadian predictive genetic testing facilities. Participants were drawn from British Columbia, Alberta, Manitoba, Ontario, Quebec and Nova Scotia. Given the community sampled was identified as being relatively small and challenging to access, purposive sampling coupled with snowball sampling methodologies were utilized.</p> <p>Results</p> <p>Surveyed lab directors and clinicians indicated that predictive genetic tests were funded provincially by one of two predominant funding models, but they themselves played a significant role in how these funds were allocated for specific tests and services. They also rated and identified several factors that influenced allocation decisions and patients' decisions regarding testing. Lastly, participants provided recommendations regarding changes to existing allocation models and showed support for a national evaluation process for predictive testing.</p> <p>Conclusion</p> <p>Our findings suggest that largely local and relatively ad hoc decision making processes are being made in relation to resource allocations for predictive genetic tests and that a more coordinated and, potentially, national approach to allocation decisions in this context may be appropriate.</p

Priority setting in health care: Lessons from the experiences of eight countries

All health care systems face problems of justice and efficiency related to setting priorities for allocating a limited pool of resources to a population. Because many of the central issues are the same in all systems, the United States and other countries can learn from the successes and failures of countries that have explicitly addressed the question of health care priorities

Resource allocation and priority setting in health care: a multi-criteria decision analysis problem of value?

A methodological approach is needed for allocating health care resources in an efficient and fair way that gives legitimacy to decisions. Currently, most priority setting approaches tend to focus on single or limited benefit dimensions, even though the value of new health care interventions is multi-dimensional. Explicit elicitation of social value trade-offs is usually not possible and decision-makers often adopt intuitive or heuristic modes for simplification purposes as part of an ad hoc decision-making process which might diminish the reasonableness and credibility of the decisions. In this paper, we suggest that multi-criteria decision analysis could provide a more comprehensive and transparent approach in health care to systematically capture decision-makers’ concerns, compare value trade-offs and elicit their value preferences. We conclude that such methods could inform the development of a decision support system in health care, contributing towards more efficient, rational and legitimate resource allocation decisions

Characteristics of Indigenous primary health care service delivery models: a systematic scoping review

Published online: 25 January 2018Background: Indigenous populations have poorer health outcomes compared to their non-Indigenous counterparts. The evolution of Indigenous primary health care services arose from mainstream health services being unable to adequately meet the needs of Indigenous communities and Indigenous peoples often being excluded and marginalised from mainstream health services. Part of the solution has been to establish Indigenous specific primary health care services, for and managed by Indigenous peoples. There are a number of reasons why Indigenous primary health care services are more likely than mainstream services to improve the health of Indigenous communities. Their success is partly due to the fact that they often provide comprehensive programs that incorporate treatment and management, prevention and health promotion, as well as addressing the social determinants of health. However, there are gaps in the evidence base including the characteristics that contribute to the success of Indigenous primary health care services in providing comprehensive primary health care. This systematic scoping review aims to identify the characteristics of Indigenous primary health care service delivery models. Method: This systematic scoping review was led by an Aboriginal researcher, using the Joanna Briggs Institute Scoping Review Methodology. All published peer-reviewed and grey literature indexed in PubMed, EBSCO CINAHL, Embase, Informit, Mednar, and Trove databases from September 1978 to May 2015 were reviewed for inclusion. Studies were included if they describe the characteristics of service delivery models implemented within an Indigenous primary health care service. Sixty-two studies met the inclusion criteria. Data were extracted and then thematically analysed to identify the characteristics of Indigenous PHC service delivery models. Results: Culture was the most prominent characteristic underpinning all of the other seven characteristics which were identified – accessible health services, community participation, continuous quality improvement, culturally appropriate and skilled workforce, flexible approach to care, holistic health care, and self-determination and empowerment. Conclusion: While the eight characteristics were clearly distinguishable within the review, the interdependence between each characteristic was also evident. These findings were used to develop a new Indigenous PHC Service Delivery Model, which clearly demonstrates some of the unique characteristics of Indigenous specific models.Stephen G. Harfield, Carol Davy, Alexa McArthur, Zachary Munn, Alex Brown and Ngiare Brow

Health impact assessment in Australia and New Zealand: an exploration of methodological concerns

This paper explores methodological issues raised by recent attempts to promote the use of health impact assessment (HIA) in Australia and New Zealand. The experiences from both countries are used to highlight important aspects of the debate about the relevance of HIA in appraising both policies and projects particularly in the three broad areas: inclusivity, legitimacy, and method. Many countries are attempting to develop HIA for use in policy development without due consideration of either important methodological issues or the workforce development and capacity-building necessary for its successful implementation.<br /