Within its universally available plan of health benefits, should a government include medication for osteoporosis or a high-cost mammography that will help to diagnose breast cancer early? Choosing one will benefit some groups of the overall population but will exclude others. How to choose the resources provided for the year are not enough for both? When setting priorities in Health refers to the decisions that determine what health services will be financed with the available resources.

Making smart choices on where to invest the scarce available resources is increasingly necessary for successful health policy making. Decisions should be guided by three key health system goals:

Quality and efficiency: getting the most for your money in terms of population health status.

Financial Protection: giving special consideration to health services that shield an individual or family from critical income losses they incur as a result of high out-of-pocket health care expenditures.

Equity and choice: providing an equitable distribution of health benefits while considering population’s preferences and choices.

Combining these sometimes conflicting priorities is a difficult balancing act. Financial protection of families is unsustainable unless the government clearly defines the limits of what exactly it will provide to its citizens; on the other hand, the establishment of explicit priorities in health should be based not only on what services provide most health for the money spent, or what services respond most to citizens’ preferences, but also on how not providing certain benefits will affect households’ economic stability and well being.

Despite dramatic advances in health over the last half century, Latin American health systems still face some of the old challenges: reducing health inequalities, increasing coverage and access to health services, and protecting households from impoverishing out-of-pocket spending. At the same time, new challenges are arising as the region goes through a rapid demographic and epidemiological transition: an ever increasing share of the population is suffering from life-long chronic diseases requiring an ongoing financial commitment to pay for necessary treatments. And the impact will not only be felt at the household level; it is projected that during the next two decades countries will need to mobilize a significant amount of additional resources to face the consequences of these changes, even without considering the rising pressure associated with the costs of new medical technologies available on the market.

In the region, these priority-setting decisions are increasingly being embedded in the adoption of explicit health benefit plans. The design and implementation of health benefit plans poses ;however, important challenges. Criteria that are used to select which health services are to be offered in a plan are subject to debate and require transparency in the decision process in order to achieve legitimacy and sustainability. In the absence of clear criteria and procedures, it is very difficult to build a health benefits plan that, at the same time addresses the most relevant health needs of a population efficiently; provides financial protection for families;is accepted by the population; and is financially sustainable.

It is precisely in this context that the IDB has been forging regional and non-regional alliances with academic institutions and other organizations involved in health priority setting to build knowledge on the design, implementation and adjustment of the health benefits plans throughout the region, and to support governments in the implementation of such plans.

The IDB has helped governments in the region to perform careful and detailed consideration of the most current technical evidence available to guide the decision making process. This improves the sustainability of the health systems and results in better, more informed decisions in terms of equity, quality, efficiency, and financial protection for the population.