Identifying values in the health policy decision-making processes about health system financing in Latin America: a critical interpretive synthesis


Oral session: Qualitative evidence synthesis methodology (2)


Thursday 24 October 2019 - 11:00 to 12:30


All authors in correct order:

Velez M1, Wilson M2, Lavis J2, Abelson J2, Florez I1
1 Universidad de Antioquia, McMaster University, Colombia and Canada
2 McMaster University, Canada
Presenting author and contact person

Presenting author:

Marcela Velez

Contact person:

Abstract text
Background: every health system in the world embodies values that guide political decisions. However, it is often not clear how values are incorporated into policy decision making about health systems. In Latin America specifically, the identification of values used in the policy decision-making process is an emerging field, and there is a paucity of evidence about the role of values and how they inform the prioritization, development, and implementation of policies in different contexts.

Objectives: our objective was to understand how and under what conditions societal values inform decisions about health system financing in Latin American countries.

Methods: we employed a critical interpretive synthesis approach to review and synthesize the published literature. We used an explicit and structured search of the indexed literature in 17 databases, followed by a more inductive purposive selection of papers from the pool of relevant empirical and non-empirical documents (n = 207) to include in the analysis. We performed the inclusion assessment in duplicate and independently. All papers included were conceptually mapped using a structured form that considered the factors and variables of two policy frameworks. Finally, we synthesized the evidence and developed a theoretical framework.

Results: we identified 116 values and developed a framework to explain how values have been used to inform policy decisions about health system financing in Latin America. This framework has four categories:
1) goal-related values (i.e. guiding principles of the health system);
2) technical values (those incorporated into the instruments adopted by decision makers to ensure a sustainable and efficient health system);
3) governance values (those applied in the policy process to ensure a transparent and accountable process of decision making); and
4) situational values (those that represent competing strategies to make decisions within health systems).

We identified four conditions under what situational values come to be influential in the policy decision-making about health system financing in Latin America, those refer to be aligned with:
1) policy legacies;
2) the stronger interest group;
3) the values of the government; and
4) international influences.

Conclusions: the review and framework that emerged from this analysis can help policymakers and stakeholders to explicitly incorporate values into the health policy process and understand how those values are supporting the achievement of health policy goals.

Patient or healthcare consumer involvement: not considered