使用数学建模确定健康优先级的经验教训（英）

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LessonsLearnedinUsingMathematicalModellingforPrioritySettinginHealth

Authors

DavidWilson,HealthNutritionandPopulationGlobalPractice,WorldBank,WashingtonDC,USA

MarelizeGorgens,HealthNutritionandPopulationGlobalPractice,WorldBank,WashingtonDC,USA

Correspondingauthor:MarelizeGorgens,

mgorgens@,

TheWorldBank,1818HStreetNW,WashingtonDC,20433,+12024731000

Keywords:prioritysetting;benefitspackages;healthfinancing;WorldBank

DisclosureofInterest

Theauthorsreportnoconflictofinterest.

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Abstract:

TheCOVID-19pandemichashighlightedtheneedforprioritysettinginhealthfinancingand

resourceallocation,spotlightingthelimitationsoftraditionalhealthfinancingstrategies.This

commentaryexplorestherelevanceofmathematicalmodelinginenhancingallocativeefficiencywithinthehealthsector,especiallyintheaftermathofthepandemic.WedrawfromtheWorld

Bank’sexperiencesinsupportingover20countriestoemploymathematicaloptimizationmodelsforprioritysetting,aimingtoachieveoptimalhealthoutcomeswithinconstrainedbudgets.Thepandemic'simpactoneconomicgrowth,revenuecollection,debtstress,andtheoverallfiscal

spaceavailableforhealthfinancinghasnecessitatedaparadigmshifttowardsprioritizing

efficiencyimprovementsinhealthservicedelivery.Weoutlinelessonslearnedfromsuch

modelingandchartfuturedirectionstoenhanceefficiencygains,includingforintegrated,

patient-centeredapproachestohealthservicedelivery.Weadvocateforflexibleandeffectivelocalizedpriority-setting,leveragingdata-driveninsightstonavigatethecomplexitiesofhealthfinancinginapost-COVIDera.

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LessonsLearnedinUsingMathematicalModellingforPrioritySettinginHealth

Conventionalapproachestohealthfinancingfocusonfivedimensions:First,increaseeconomicgrowth,sothereisalargerpietoshare.Second,improverevenuecollectionsogovernmentscancapturealargershareoftheeconomyforpublicexpenditure.Third,strivetomitigatedebtstresssocountrieshavemoreresourcestoallocatetohealthandthesocialsectors.Fourth,improve

allocativeefficiencyinthehealthsectorthroughbetterprioritization,allowingMinistriesof

Healthandtheirdevelopmentpartnerstodirectfundingtoareaswhereitcanhavethegreatestimpactonpopulationhealthoutcomes.Fifth,enhancetechnicalandproductionefficiencytoallowMinistriesofHealthtodeliverhealthservicesusingmodalitiesandmechanismsthat

ensurecost-effectivedelivery.1

COVID-19hasprofoundlyanddifferentiallyaffectedhealthfinancing

Inthiscommentary,wefocusnotonlyonthelessonsofCOVID,butalsothelessonsaboutusingmodelingforprioritization.COVIDhasmadelessonsaboutprioritizationmoreurgentthaneverbecauseofitsimpactoneconomies,budgetsandhealthfinancing,healthsystemperformance,

andtheworkforce.

TheCOVID-19pandemichasprofoundlyaffectedfivedimensions:(a)Economicgrowthis

stunted,especiallyinlow-incomecountriesthatneedfundingthemost,puttingextraordinary

strainonhealthbudgetsandfiscalspaceavailableforallocationtothehealthsector.Koseetal.showedthatmanycountries,especiallylower-middle-incomecountries,willhavesmaller

economiesby2025thantheywouldhavehadwithoutCOVID-19.2(b)Intermsofrevenuecollection,evenpriortoCOVID-19,manycountriesespeciallylow-andmiddle-income

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countriesraisedlessrevenueasashareofgrossdomesticproduct(GDP)(Figure1).3Lower

revenuecollectionasashareofGDPinlow-andmiddle-incomecountries(LMICs)isoftenduetohighlevelsofinformaleconomicactivity.Inthesesettings,themostefficientrevenue

collectionmethods,suchastaxesontheconsumptionofcellularorinternetservices,ormobilemoney,maydisproportionatelyaffectlow-incomegroups.4COVID-19exacerbatedthe

informality,resultinginproportionatelyreducedrevenuecollection.(c)COVID-19hasamplifiedtheneedtouseeveryhealthdollarwell:allocative,production,andtechnicalefficiencyare

arguablymuchmorecriticalthaninthepast.IntheaftermathofCOVID-19,bothdevelopmentassistanceandnationaldomesticbudgets,especiallyforhealth,aremorelimitedanddebated.

ThissituationindicatesthatitiscrucialforMinistriesofHealthtoprioritizeefficiencyimprovements.5

Figure1:GovernmentrevenueasashareofGDPismuchlowerinlow-incomecountries

Source:IMF,2023.

/external/datamapper/rev@FPP/USA/FRA/JPN/GBR/SWE/ESP/ITA/ZAF/I

ND

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Governmentsarefacingincreasingpressureastheirhealthresources,alreadylimited,continuetodiminishinsomecases..Theymustsimultaneouslyre-buildessentialservices,enhanceboth

essentialandpublichealthservices,prepareforfuturehealthemergenciesregardlessofetiology,addresstherisingdiseaseburden,meetthedemandsforperson-centeredhealthcareandbudget

foranexpandingrangeofnewhealthproducts,frominnovationsinvaccinestocancer

treatments.Thiscomprehensiveandexpandingagendawillonlyintensifywiththeadditionalchallengesposedbyclimatechange.

Toaddressthisagenda,amulti-prongedapproachisneeded.EconomicgrowthinLMICsis

criticaltoincreaseresourcesavailableforhealth.Equitableandefficienttaxcollectionstrategiesareneededtoincreasepublicrevenuecollection.Allocativeefficiencyimprovementsthrough

priority-settingcanhelpoptimizenationalhealthbudgetallocationsandexpenditures.Finally,whenimplementinghealthservices,itisimportanttoconsiderbothtechnicalandproductionefficiency.Thiscommentaryfocusesonallocativeefficiencyimprovementsthroughpriority-settingandexamineslessonslearnedfromtheapplicationofmodelingforimprovementsin

efficiency.

Prioritizationiscriticaltopost-COVIDhealthfinancingconsiderations

Prioritizationmaypromoteavailabilityofessentiallifesavingsolutionsinmanydimensionsofpublichealthandiscriticaltothepost-COVIDhealthfinancingagenda.Priority-settingshouldbedonefollowinganagreedsetoffourprinciples:(a)basedonsetguidelines(i.e.,pre-

determinedcriteria);(b)adheretowell-defined,context-specificprioritizationstandards;(c)be

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groundedindatasuchthatdecisionsaredirectlyinformedbyevidence,ensuringoptimalchoicesaremadeusingcost-effectivenessdata;and(d)executedinwaysthatarecollaborativeandopen,meaningtoengageallpertinentpartiesthroughouttheprocessandprovidingclearreasoningforallfinancialchoices.6

Consideringtheseprinciples,Bloometal.conductedareviewofpriority-settingpracticesin10countries.7Theyfoundthatinthe10countriestherewasagradualmovetowardspriority-settingpracticesbeingevidence-basedandresponsivetoacountry’sneeds.Priority-settingexpressed

itselfinthesecountriesthroughtwomaindimensions:(a)Countriesmovedfrominputline-itembudgeting,toallocatingresourcesbasedonvariousformsofprogrambudgeting,or(b)countriesdefinedatleastonepublicbenefitspackage,eventhoughitmaynothavebeenusedextensivelyinpractice.

Therewerealsochallengesforpriority-setting;notably,theuseofquantitativetools,suchascostingorpriority-settingtools,toprioritizeandallocatebudgetsremainedlow.7Yet,healthsectorbudgetsthatprioritizeusingmathematicalmodelsexhibitobservablyhigherallocativeefficiencies.4

Thispaperconsiderstheauthors’recentexperienceattheWorldBank,workingwithpartnerstousemathematicaloptimizationmodelstoguideprioritization,whilerecognizingthatsuch

modelsareoneofseveralinputsintoprioritization.Widerethicalandlegaldimensionsmustbeconsidered,andpoliticaleconomyconsiderationsexertamajorinfluenceonprioritization.

MinistriesofHealthmaynothavethepowertosettheiroverallavailablefundingfortheyear,

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buttheyoftenhavemoreflexibilitytodeterminehowfundsareallocatedwithinthatbudget.Extensivedataontheseallocationscanallowforgreatercapabilitiestoadvocateforspecificfundingchoicesandargueforlargerbudgets.

WorldBanksupportsgovernmentstousemodellingforprioritysettinginhealthsector

Consideringthesepriority-settingpractices,theWorldBanksetoutduringthelastdecadeto

workwithover20countriestoexplorewaysinwhichpriority-settingcouldbeimprovedusingmathematicaloptimizationmodeling.

Workingwithacademicpartners,theWorldBankhassupportedcountriestousemathematicaloptimizationmodelingtoimprovebudgetallocationsalongsidehealthprogrambudgeting

approachesinspecificdiseaseprogramssuchasHIV,tuberculosis,andmalariaandfornutritionprogrambudgeting.8,9Unlikeotherbudgetingapproachesthatstartwiththecostsand‘rollthemup’intoatotalorprogram-specificbudget,mathematicaloptimizationbudgetingstartswitha

givenresourceenvelope.Resourcesshouldbeallocatedtospecificprogramsbasedontheir

epidemiologyandcurrentresourceallocationstooptimizeoutcomes,whichinvolvesboth

reducingmorbidityandreducingmortality.10Theseoptimizedfundingallocationscanthenbecomparedwithcurrentfundingallocationstomakerecommendations,suchastoincrease

spendingtocommunity-basedantiretroviralservices,ordecreasefundingforgeneralpopulationbehaviorchangeprogramsincountrieswithconcentratedHIVepidemics,whereprogramsfor

thegeneralpopulationarelesseffective.

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Inotherwords,mathematicaloptimizationmodelsthatuseoptimizationalgorithmscancalculateoptimalinvestmentallocationsacrossdifferentbudgetscenarios.Thesemodelscanalsobeeasilyadjustedifbudgetsriseorfall.

Mathematicalmodelsusingoptimizationalgorithmscanbeusedtocalculateoptimalinvestment

allocationsunderarangeofbudgetscenarios.Suchprioritizationstudies,utilizingvarious

modelsliketheOptimamodel,canleadtosignificantimprovementsinbudgetallocations.Thesestudieshelpshiftbudgetstowardsmoreoptimalinvestments.Theyprovideobjectiveevidencetoarmtechnicalspecialiststotackleunjustifiedpoliticaldistortionsinallocations.Prioritization

modelshaveprogressedfromfocusingondisease-specificprioritizationtoguidingoverallhealthsectorallocations.Asoneexample,theOptimamodelhasshownpromiseinenhancingprioritydiscussionsbyeffectivelyhighlightingprioritieswithindefinedresourceconstraints.

TheOptimamodelhasimprovedresourceallocationinover40countriessinceitsinceptionin

2012.12HIVstudiesandapplicationsusingprioritizationalgorithmshaveinformedseveral

internationalhealthfundinginstitutionsandhavebeenusedtodetermineoptimaldistributionofresourcesin23differentcountriestomeetnationalHIVtargetswhileconsideringlogistic,

political,andethicalconstraints.13Themodelsdeterminedthatre-allocationofhealthspendingcouldreducenewHIVinfectionsby18%in12countriesandreduceestimatedHIV-related

deathsby29%onaverageineightcountriesby2030.14Algorithmicoptimizationmodelscan

simultaneouslyprioritizeallocative,production,andtechnicalefficiencies.Forexample,itisnotonlyimportanttofinancebednetsformalaria,butalsotothinkoftheirdeliverymodalitiesandmechanismsfordifferentpopulations,andhowtheyaredistributed.

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Suchprioritizationstudiesmayyieldpromisingimprovementsinbudgetallocationsandcanhelpshiftactualbudgetstowardsmoreoptimalinvestments,asdemonstratedbytheexamplefrom

SudaninFigures2,3,and4.Figure2showshowtheexistingbudgetcanbereallocatedfor

greaterimpact.Figure3showstheoptimalallocationunderarangeofbudgetscenarios.Figure4showshowbudgetswerereallocatedfromtheexistingtoanoptimizedbudgetallocation—it

showsthemodelsweresuccessfulindrivingreal-worldspendingchanges.WhatmadetheSudanexampleparticularlyimpactful,isthattheabsolutebudgetedamountforkeypopulation

programsincreaseddespiteanoveralldecreaseinfunding:“Whenbudgetswereassignedfor2015–2017,thetotalamountoffundingwaslessthan2013levels.However,duetothe

optimizationresults,morefundingwasshiftedtowardsprogramstargetingkeypopulations,predictedtoleadtoareductionoftotalnewinfections.”15

Figure2:Spendingpatternin2013andoptimizedallocatedtominimizenewHIV

infectionsbetween2014and2020,at2013resourcelevelof12.3USDmillioninSudan

Source:WorldBank,2015

Figure3:OptimizedallocationstominimizeHIVincidenceby2020atdifferentbudgetlevelsinSudan

Source:WorldBank,2015

Figure4:ReallocationofHIVresourcesinthe2015-2017budgetfortheHIVResponseinSudan

Source:WorldBank,2015

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Threeimportantfeaturesstandoutabouthowthisworkwasdone:First,duringtheprocessof

usingmathematicalmodelsforpriority-settingandbenefitspackagedetermination,theWorld

Bankanditsacademicpartnersaimedtobeastransparentaspossible.Anonline,cloudversionofthemodelwasmadeavailableforanypersonauthorizedbythegovernmenttouse,training

courseswereconducted,andlocalacademicinstitutionsweretrainedtousethemodelsinthe

future.Second,effortsdidnotstopwithdisease-specificmodeling.Usingthesedisease-specificoptimizationpractices,theWorldBankalsoworkedwithacademicpartnersandthreecountries,Zimbabwe,Coted’Ivoire,andZambia,topilotatoolforhealthsector-wideprioritizationusingadifferentmodel,theHealthInterventionPrioritizationTool,orHIPTool.Thesepilotefforts

showedthatprioritizationacrossthehealthsectorwaspossible,butthatmathematicalmodelingwasonlyonestepaspartofawiderpolicyandprogramdialogueprocesstohelpmovethe

needletowardsmoreeffectiveinterventions.Thirdly,intheZimbabweexample,wefoundthatthemostsavingscouldbefoundinchangingthemodalitythroughwhichservicesaredelivered,suchastaskshiftingtoallowmoreworktobedonebycommunityhealthworkersandprimaryhealthcarestaff,asopposedtochangingwhichservicesareprovided.

Lessonslearnedinusingmathematicalmodelingforpriority-settinginhealthsector

Manyimportantlessonswerelearnedaboutwhereandhowtoincreasefundingballoonsand

howtodobetter,despiteincreasesinoverallfundingnotbeingavailable.Allthestudieswere

conductedwiththefullparticipationoftheMinistryofHealthandnationalacademicinstitutionsandledtoincreasedcapacitytousemathematicaloptimizationmodelsforpriority-setting.Theseexperienceshaveshownthattoharvestfurtherefficiencies,thenextwaveofprioritizationeffortswillneedtobemoredetailed,integrated,andwiderangingbyaddressingtheseissues:

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First,weneedtoincorporatetheinterplaybetweenallocativeandtechnicalefficiencyby

expandingtheconceptofpriority-settingtoalsofocusonthemodalityofservicedelivery.To

date,discussionsonwhichinterventionsshouldbefundedhavelargelybeenseparatedfromhow

theyareimplemented,overlookingthereciprocalloopbetweenallocativeandimplementationefficiencies.Itisnotjustwhatgetsimplemented,butthemodalitiesthroughwhichitgets

implemented.Mobiletechnologiesaspatientremindersmightworkwellforsomepopulations,butnotforotherpopulations.Today,differentiatedcareisapivotalelementofperson-centeredhealthsystems.Priority-settinghaspredominantlycenteredonthetypeofservice,suchas

antenatalcare,ratherthanitsdeliverymethod.Forinstance,insteadofanapproachthat

mandateseightface-to-faceantenatalcarevisits,amoredifferentiatedmethodmightinvolvephoneremindersfortwoantenatalcarevisits,discussionswithamidwife,andareferraltoanobstetricianifnecessary.

Second,futureanalysesofprioritizationwillneedtoexamineservicedeliveryquality,reach,andscale.Itisnotjustwhatgetsfinancedorhowitgetsdelivered,butitsqualityandwhetheritleadstomorehealth.Somedeliverymodalitiesmightyieldbetterqualityandshouldbefavored.

Third,geospatialanalysesofvulnerablepopulations,serviceaccess,demand,andutilization,whichreceivedgrowingattentionduringCOVID-19,mustalsobeincluded.Theconceptofprioritysettingwillneedtobeexpandednotonlytofocusonhowmuchfundingtowhich

service,butalsowheretheserviceisdelivered.AWorldBankcasestudyonIndonesia,forexample,usedsocialvulnerabilityindexingframeworkwithgeospatialanalysesanddatato

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createaCOVIDVulnerabilityMappingDashboardthatexaminesanddisplayssocial

vulnerabilityindicesatthenationalandsubnationallevelsinIndonesia.Thisdashboard

integrateddataonlocalhealthcapacitywithinformationonsociallyvulnerablecommunitiestoprovidepolicymakersinsightsforallocatinghealthresources.Policiesinformedbybaselineanddynamicgeospatialdatawillguidelimitedresourceallocationtooptimizehealthinterventions.16

Fourth,alongsidegeospatialdata,futureprioritizationanalyseswillneedtoincorporategreaterdifferentiationandpersonalizationofservices:Patient-centeredprioritization.Thisimplies

differentiationofservicedeliverymodalitiesfordifferentpopulationsandthatdifferentsetsofprioritiesmightbeapplicablefordifferentpopulations.Priority-settingfromtheperspectiveofpatientsoftenlooksdifferentfromtheperspectiveofhealthcareproviders,whichhasbeenthefocusofprioritysettingefforts.

Fifth,ensurethatefficiencygainsarerepurposedwithinthehealthsectorbybetterintegratingthemwithpost-budgetingprocesses.Historically,efficiencywasseenasaprimarymethodto

boostthehealthsector'sbudget.However,evidencefromvariouscountriessuggeststhatjust

improvingefficiencydoesn'tnecessarilyincreasethehealthbudget.Barroyetal.suggestedthatefficiencygainsdidnotalwaysresultinsavingsthatweretangibletothehealthsector,as

illustratedinFigure5.Forthehealthsectortobenefitfromefficiencyimprovements,fourcriteriamustbesatisfied.13

•Theefficiencystrategiesshouldbeclear-cutandspecificallyaimedateitherchangingthe

costoralteringthecombinationofresources.

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•Suchstrategiesshouldyieldsignificantmonetarybenefits.

•Thepublicfinancialmanagement(PFM)systemsshouldensurethatthesemonetary

benefitsremaininthehealthsectorandareredirectedtowardshigh-priorityhealthneeds.

•OnlyaversatilePFM,fromcentraltopurchaserandproviderlevels,ensuresthatthese

savingsareretainedandreallocatedwithinthesector.

Iftheseprerequisitesarenotinplace,insteadofenlargingthehealthbudget,enhancedefficiency

mightinadvertentlyleadtoreducingit.Thiscandiscouragefurtherendeavorstoenhance

efficiency.Moreexamplesofhowpriority-settinghasimprovedmorbidityandmortality,arealsoneededtoshowcountrieswhyitisimportantandrelevanttothem.

Figure5:Interplaybetweenefficiencygainsandsavings

Source:AdaptedfromBarroyetal,2017

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Sixth,futureprioritizationeffortswillneedtoconsidertheextenttowhichintegratedcare

packageofservices,personalizedforspecificpatients,canbeprioritizedaspackagesandnotasverticalandseparatestandaloneservices.Integratedservicesposeavarietyofchallenges,most

notablychallengesinreimbursement,inmonitoringandevaluation,andinpriority-setting.Thereremainseveralcriticalbarrierstointegratedcaremodelsthatprioritizepatienthealthincluding

long-termfinancialsustainabilityandthelackofintegrationbetweenhealthandsocialcare

providersandavailabilityofhumanresources.17Resourcesdedicatedtofinancingschemesandintegratedpublichealthandsocialsectorscanfacilitatesuccessfuldeliveryofintegratedcarepackageservicestopatients.Forexample,inCentralandEastEuropeancountries,future

integratedcareprioritizationwilladdressagingpopulationswithrisingnumbersofpatientschronicmultimorbidity.17

Seventh,priority-settingandhealthbenefitspackagesarenotthesame.Evenafterpriority-

settinghasbeendone,theprocessofdevelopingabenefitspackagerelevantforthatcountryandhowitgetsreimbursedthroughthefinancingsystemrequiresextensiveadditionalwork,as

describedinFigure6.Beyonddefiningthebenefitspackage,thenextchallengetowards

implementationisnontrivial.Itrequiresongoingpolicydialoguetotranslatethefindingsofamathematicalmodelintochangespracticesandprioritiesontheground.Thepolicydialogueincorporatesinsightsfrommathematicalmodeling,butmustalsobeattentivetopolitical

economyconsiderations.

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Figure6:Priority-settingispartofthebudgetingprocessandneedstobefollowedbyresourceallocation

Source:Bloometal.,2020

Conclusion

Priority-settingwasafocuspriortoCOVID-19,particularlyasitrelatestodisease-specific

programs.Forinstance,decisionsweremaderegardingtheallocationofHIVbudgetsbetweentreatmentandprevention,aswellasidentifyingwhichpopulationstotargetforHIVpreventionbasedonvariouscountrycontexts.Althoughcosteffectivenessanalysesweremainlyusedfor

thesetypesofanalyses,inthelastdecade,theuseofmathematicalmodelsforpriority-settingindisease-specificprogramshasgainedmomentum.

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Becauseoftheirnature,mathematicalmodelsforpriority-settingcanbeusedforhealthsector-widepriority-setting.Suchapproacheshelpgovernmentsconsidertrade-offsbetweenprogramsinamoregradualwaybyassigningvaryingamountsofmoneytoaprograminsteadofan

absolutedecisiontoeitherimplementaprogramornot,whichiswhatacomparativecosteffectivenessanalysisprocessresultsin.

Effortstofocusonpriority-settingandcriticallyexaminehowitisdoneacrossthehealthsectorhavegainedadditionalmomentumforsixreasons:(1)thehealthfinancingconundrumthatthe

COVID-19pandemiccaused,(2)theincreasingcomplexityofhealthservices;andthatmorearedeliveredinaseamless,‘basketofservices’waywhereavisittoasingleprovidercouldresultinmanydiseaseburdencausesbeingaddressed,(3)thefocusondigitalmodalitiesofservice

delivery,whichmighthavedifferentcost-effectivenessparameters,(4)differentiatedcare

models,whichresultsinthesamehealthservicebeingdeliveredtodifferentsub-populationsindifferentways,basedontheirpreferences,(5)healthsystemredesignefforts,whichdesignatesthatnotallhealthservicesaredeliveredinalllocations(bundling,forexample,complex

pregnancyanddeliverycaretoafewspecializedfacilities),and(6)adeepenedunderstandingoftheroleofenvironmentaldeterminantsofhealth,forwhichprogramsoutsidethehealthsector’spurviewisoftenneeded.

Priority-setting,regardlessofwhethermathematicalmodellingwillbeusedinfuture,willonlybecomemorecomplexinthefuture.Thecomplexityofhealthcareisincreasingduetobroadersystems-levelchangesinhowhealthcareisperceived,higherexpectationsfromclientsofhealthsystems,andaddedpressuresonhealthsystems.Thesepressuresincludetheneedtoaddressnot

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onlysocialdeterminantsofhealth,butalsoenvironmental,commercial,anddigitaldeterminants.Additionally,thereisagrowingimperativetoprepareforfuturehealthemergencies.

Ashealthsystemsevolveanddigitalize,datawillbeavailablemorequickly,whichwillhelptoaddressamajorchallengeconfrontingmathematicaloptimizationstudies—timely,qualitydata.Thesedatacandrivethenextinnovationinpriority-settingusingthelessonsdescribedinthis

article:differentiated,patient-centered,agile,nimble,andlocalizedpriority-settingthatallowformicro-adjustmentstobetterguidehowservicesaredeliveredinwaysthatareintegratedwith

otherpriority-settingeffortsinothergeographiesorwithothermodalitiesofservicedelivery.

Priority-settingmethodsneedtoadapttoanincreasinglycomplexcontextandsetof

governmentspriority-settingpriorities.Inconsideringwhichpriority-settingapproachesaremostsuitabletoanswerthisawideningsetofquestions,itisimportanttoconsiderlimitationsinterms

ofeffectivenessdataandcostdata,thecomplexitiesofcostdatawhenservicesareimplementedjointly,thenotionofusingcostfunctionsinsteadoflinearcostassumptions,andtheinherent

assumptionsandsimplificationsbuiltintomathematicalmodels.

Futuresuccesswilldependonmanyfactors,includingtheextenttowhichthoseconcernedwithpriority-settinginhealth,anddevelopingmethodsforit,canadopta‘fromsinglenoteto

symphony’approachtopriority-setting.Ashealthsystemscontinuetoevolve,thispaper

advocatesforagile,nimble,andlocalizedpriority-setting,leveragingdata-driveninsightstonavigatethecomplexitiesofhealthfinancinginapost-COVIDera.

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References

1.KutzinJ.,WitterS.,JowettM.,andBayarsaikhanD.2017.HealthFinancingGuidanceNo3:DevelopingANationalHealthFinancingStrategy:AReferenceGuide.Geneva:WorldHealthOrganization.

/iris/bitstream/handle/10665/254757/9789241512107-eng.pdf

2.Kose,M.Ayhan,andOhnsorge,Franziska,eds.2023.FallingLong-TermGrowth

Prospects:Trends,Expectations,andPolicies.Washington,DC:WorldBank.License:CreativeCommonsAttributionCCBY3.0IGO

3.OECD.2022.TaxPolicyReformsinLow-andMiddle-IncomeCountries:Policybrief,

OECD,Paris,

/tax/tax-policy/tax-policy-reforms-in-low-and-middle-

income-countries-policy-brief.htm

4.Mills,L.2017.Barrierstoimprovingtaxcapacity.K4DHelpdeskReport.Brighton,UK:

InstituteofDevelopment.Studies

.uk/media/5b9b914de5274a138c0a0b20/K4D_HDR_

Tax_capacity_barriers_.pdf

5.Kurowski,C.,Kumar,A.,MiesesRamirez,