Abstract

BACKGROUND & OBJECTIVE: In view of the budget limitations resulting from the downturn in the Kuwaiti economy, it is crucial to evaluate the process of priority setting within the health system to identify strengths and weaknesses of this process within both the public and private sectors. Once the weak points are identified, policy makers can work with hospital administration staff to upgrade the process with the aim of utilising health resources more efficiently. The purpose of this study is to give decision makers some insight on the perspective of hospital managers regarding the current process of priority setting, and suggest ways to improve this process. Additionally, this study will provide the opinions of hospital managers in questioning the effect of certain healthcare policies, currently given top priority, on healthcare system efficiency. The views of the hospital managers interviewed indicate their preferences in priority setting and the changes in health spending they believe are required.

METHODS: A qualitative study was conducted using semi-structured, face-to-face interviews with 14 managers from public and private hospitals in Kuwait. Content analysis was used to produce major themes and sub-themes from the interview transcripts.

RESULTS: While several similarities and differences in the priority-setting process between the public and private sectors were apparent, the main strength in the process that most managers from both sectors mentioned, was that it was simple, systematic, comprehensive and democratic. The several weaknesses of the process include it not being evidence-based due to the lack of accurate and up-to-date data. Also, the discrepancy between the official statements made and the actual practices of health decision makers in the country demonstrate the confusion around the priority-setting process. Most respondents, from both sectors, thought that the availability of a clear and well-communicated national health strategic plan would facilitate the necessary modifications in legislative, structural and administrative strategies to streamline the processes of allocating resources and setting priorities. For example, most respondents believed that the disadvantages of the costly practice of sending patients abroad for treatment and its effect on resource allocation outweighed its advantages. Further, the managers from both sectors had different perceptions regarding the policy of private health insurance for retirees. These two policies, according to some hospital managers, added strain to the health budget and undermined trust in the public-health sector.

CONCLUSION: This study examined the perspective of hospital managers regarding the process of healthcare priority setting in Kuwait, and ways to improve it. Priority setting could be improved by having a better understanding of its strengths and weaknesses. The study concludes that health decision makers should remain responsible for accepting and implementing evidence-based, systematic processes of resource allocation. Additionally, continuous monitoring and evaluation of the impact of health policies will be required to improve overall health outcomes.        

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