Abstract
Background: Although values underpin the goals pursued in health systems, including how health systems benefit
the population, it is often not clear how values are incorporated into policy decision-making about health systems.
The challenge is to encompass social/citizen values, health system goals, and financial realities and to incorporate
them into the policy-making process. This is a challenge for all health systems and of particular importance for Latin
American (LA) countries. Our objective was to understand how and under what conditions societal values inform
decisions about health system financing in LA countries.
Methods: A critical interpretive synthesis approach was utilised for this work. We searched 17 databases in
December 2016 to identify articles written in English, Spanish or Portuguese that focus on values that inform the
policy process for health system financing in LA countries at the macro and meso levels. Two reviewers
independently screened records and assessed them for inclusion. One researcher conceptually mapped the
included articles, created structured summaries of key findings from each, and selected a purposive sample of
articles to thematically synthesise the results across the domains of agenda-setting/prioritisation, policy
development and implementation.
Results: We identified 5925 references, included 199 papers, and synthesised 68 papers. We identified 116 values
and developed a framework to explain how values have been used to inform policy decisions about financing in
LA countries. This framework has four categories – (1) goal-related values (i.e. guiding principles of the health
system); (2) technical values (those incorporated into the instruments adopted by policy-makers to ensure a
sustainable and efficient health system); (3) governance values (those applied in the policy process to ensure a
transparent and accountable process of decision-making); and (4) situational values (a broad category of values that
represent competing strategies to make decisions in the health systems, their influence varying according to the
four factors)...