Bangkok Statement on Priority-Setting for Universal Health Coverage
We, Ministers of Health and participants of the Prince Mahidol Award Conference 2016, gathered in Bangkok on 29-31 January 2016 to learn and share experiences, namely:
- Recalling global evidence of the need for priority-setting set out in the 2010 World Health Report, the 2012 UN General Assembly Resolution on Universal Health Coverage (UHC), World Health Assembly 2014 Resolution “Multisectoral action for a life course approach to healthy aging” (A67/23), and the 2015 Global Goals for Sustainable Development.i
- Recognizing that UHC will require difficult trade-offs between expanding priority services, including more people, and reducing out-of-pocket payments, and the fact that demand for health services may be infinite while resources are limited and donor contributions are declining in some settings.
- Recognizing that all health systems must set priorities over time, no matter their wealth.
- Noting that ad hoc rationing is ubiquitous, with the possible effect of undermining national goals for ensuring equitable access and managing spending and costs, such that many of the most cost-effective interventions, particularly those that favor the poor, continue to be under-provided, while less cost-effective interventions consume public subsidy.
- Recognizing the need for more explicit priority-setting considering fairness and equity, and based on cost-effectiveness with respect to health outcomes, while also incorporating due consideration of financial protection, ethical principles, social values, political feasibility, and public health security.
- Noting that priority-setting is best seen as a continuous process, where priorities will change as populations age, financial resources grow, and healthcare technologies and prices evolve.
- Recalling that priorities are only meaningful if they are translated into action by regulation, budget allocations, purchasing and procurement, supervision, medical curriculum , and similar.
- Noting the legitimate desire of interest groups and other stakeholders to influence priority-setting processes, and the need to establish a fair, transparent, inclusive and just process for their participation.
- Recognizing that progressive realization of the right to health requires national and global health stakeholders to work synergistically to support priority-setting processes that ensure alignment, participation, transparency, empowerment, nondiscrimination, and accountability.
- Recognizing that better priority-setting processes can help to forecast real demand for cost-effective innovations, and to establish rules of the game and predictability that can benefit public payers and encourage innovation.
- AGREE to work together to develop fair, transparent, systematic and evidence-based priority-setting processes that will support UHC goals, in particular to:
National governments (with support from global donors, if appropriate)
a. Embed and design evidence-informed and accountable priority-setting processes into UHC decisions taken by public agencies.
b. Mobilize university and research centre support for governments’ priority-setting efforts and the translation of evidence into better policy decisions.
c. Ensure that patients, civil society, and the general public have avenues to meaningfully participate in and inform priority-setting processes.
d. Monitor de facto implementation of the normative priorities that emerge from the abovementioned processes.
Development partners (including bilaterals, regional and multilateral banks, foundations, and other international organizations)
e. Offer financial or technical support for strengthening of national systems and technical capacity for priority-setting for health, with particular attention to countries undergoing transitions from aid.
f. Enhance their own processes for evidence-informed priority-setting.
g. Align with country priorities to support priority-setting for UHC.
All stakeholders (including industry, academia, professional organizations, and patient groups)
h. Create an enabling environment for priority-setting processes by informing, creating and abiding by fair rules of the game that can be respected by all stakeholders in the system.
i. To collaborate, mutually support, and share learning and experiences in priority-setting as a data and knowledge-based global public good.
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