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Across the world, policy makers face the challenge of setting health care priorities, balancing the objectives of securing high quality, comprehensive healthcare without financial barriers to access. Priority setting involves technical analyses of clinical and cost effectiveness. However, it also involves social value judgments: these are judgments about, for example, justice, solidarity, respect for persons and dignity as matters of substance, and transparency, accountability and participation as matters of process. Often these judgments are controversial, and not least because decisions in health priority setting inevitably create 'winners' and 'losers' - those who receive treatments, and those who do not. As such, it is especially important that decisions in this field are clearly thought through and can be explained and justified to the public. However, in many contexts the social values involved in health priority setting are implicit and go unrecognised by policy makers - there is often a sense of 'muddling through', especially in countries where processes of health technology assessment are newer, less well established or less efficient. The challenge of addressing issues of social values in these countries is no less demanding, but the capacity to address it when many other challenges press can be limited, given the complexity of the values-based issues and the unfamiliarity of some policy-makers with them. This project aims to develop a template which will be a practical tool to help policy makers in their deliberations around social values in health priority setting. The template will set out the relevant social values and the range of ways in which they can be interpreted, in an intellectually coherent yet practical and accessible way. The template aims to offer a ready 'checklist' which can be easily adapted to local circumstances, and by which all policy makers can more easily identify, articulate and better address issues of social values in their decisions. It will enable clearer identification of the values and their social and ethical implications and, as such, will help policy makers both to reason more cogently in their deliberations and, ultimately, to render the decisions which issue from those deliberations more socially justifiable. In order to do this, and to ensure that the template is fit for purpose, we intend to work from information in real examples of priority setting decisions obtained from a network of international policy makers that we have helped establish with colleagues at NICE. We intend to expand the range of case studies we already have, and to establish an interactive web-based resource to house these and our ongoing research. We intend for the site to be a resource where policy makers can share experiences and learning, and where they can feed in their ideas to our research. There is much enthusiasm amongst the existing members of the network for this, and we intend the website to be not only a valuable resource in itself, but also to be a means of extending the existing network and strengthening links amongst partners. We will also hold a workshop at the 2012 Health Technology Assessment international conference which will provide an opportunity for the network to meet and for us to consult with members on the development of the template and to test its applicability. If funding for this project were secured, it would prepare the ground for a larger related project, a proposal for which is to be submitted together with NICE (the subject of a separate application and still under development). That larger project proposes to investigate empirically, through cross-national comparative analysis, how social values play a part in health priority-setting in different national contexts. Both the research carried out in the present project and the relationships built with colleagues in the network will be invaluable to this larger piece of work.
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