It is often not clear how values are incorporated into policy decision-making about health systems. This is perhaps not surprising given the complexity of decision-making about health systems, the wide range of values prioritized (and advocated for) by different stakeholders, the broad array of sources for or mechanisms available to identify values, and the many ways in which values can drive policy decisions, as well as the reality that policymakers often do not want to be explicit about the values used in policy decision-making process. Using synthesis and qualitative research methods, this dissertation investigates the role of values in policy decision-making about health system financing in Latin America and contributes to the understanding of this field by providing insights for policy and research. The dissertation moves from a general and descriptive focus to a specific and explanatory focus. First, a critical interpretive synthesis was used to develop a theoretical framework that identifies how and under what conditions values inform policy decision-making about health system financing in Latin American countries. In chapters 3 and 4, the focus narrows by using an embedded multiple-case study design that analyzes two specific decisions in each of Chile and Colombia. Frameworks that explain government agenda setting and policy development and the theoretical framework developed in chapter 2, are used to analyze these decisions. The second study (chapter 3) is a discourse analysis which qualitatively assess how declared values inform the four decisions in Chile and Colombia. The third study (chapter 4), draws on in-depth qualitative interviews to understand how and why policymakers and stakeholders use declared and undeclared values in those four decisions in Chile and Colombia.
The research chapters build on each other and make substantive, methodological and theoretical contributions. The dissertation provides a rich understanding of the roles of values in health system financing decisions through a critical interpretive synthesis and two qualitative studies, adding to the evidence base that stakeholders and policymakers can draw from when making or shaping policy decisions. These studies collectively build an understanding about what values inform the health policy process in Latin America, how those values work, under what conditions they come to be influential, how they are applied in real decisions, and why policymakers and stakeholders perceive that values play a role in real decisions. All of this evidence has contributed to the development a new theoretical framework about the roles of values in health systems. / Thesis / Doctor of Philosophy (PhD) / Values are important at all stages of the policy process. However, it is often not clear how they are incorporated into policy decision-making about health systems. In Latin America, the study of the role of values and how they inform the prioritization, development, and implementation of policies in different contexts, is an emerging field. This dissertation addresses key gaps in understanding by: 1) developing a framework, which can be used as a tool by policymakers and stakeholders to identify which values support or compete with their initiatives, how to make initiatives more socially supported, and how to focus policies according to the goals of the government and the health system; 2) analyzing how, based on media reports and governmental and non-governmental documents, values have informed two health system financing decisions in each of Chile and Colombia; and 3) examining the views and experiences of policymakers and stakeholders about how and why values were used in decision-making processes related to the same two policy decisions in each of Chile and Colombia.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/24217 |
| Date | January 2019 |
| Creators | Velez, Claudia Marcela |
| Contributors | Wilson, Michael G., Health Research Methodology |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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