In this article, we argue that prioritization in some Latin American countries tends to be fair and justified when the legal instruments that define their process include certain elements of the A4R framework and certain values described by Clark and Whales. Therefore, we have redefined the four elements of the A4R so that we can determine whether the prioritization process reflects some of its core ideas and to what extent the elements (transparency, relevance, review and revision, and oversight and oversight) can be found in legal instruments. In addition, we redefined six social values (participation, clinical effectiveness, cost-effectiveness, equity, solidarity, and autonomy) of the Clark and Wale framework to assess content prioritization to determine the extent to which it has been incorporated into legal instruments. We have included Clark and Whales` values in the A4R relevance element to clarify the concepts involved in why actors make certain decisions when setting priorities. The definitions are found in Figure 1.16 The subordinate perspective is that of actors whose activities are subject to the law and who assess their room for manoeuvre, maximize this space and pursue their own objectives and evaluate solutions to see whether they are more or less conducive to achieving these objectives (“work under the law”). This is the view generally taken by lawyers who defend the interests of their clients in court; But other people, often secretly, may also argue from the subordinate point of view. Unlike the sovereign perspective, the subordinate perspective does not seek to change or criticize the law, but treats it as given and rather tries to find a construct that best serves the interests of a particular party. Unlike the domestic perspective, the subordinate perspective is not just about the “right” decision, but about extending and elaborating legal norms so that they correspond to their own preferences to such an extent that they are or could be acceptable as an authoritative promulgation or enforcement of the law. Malaysia`s national economic policy had been formulated with two objectives in mind: eradicating poverty and restructuring society. In this article, we trace the origins of the policy and examine it from a legal perspective. We found that, although the Directive is not a law within the meaning of traditional standard case law, it has nevertheless been complied with. We argue that this compliance is not due to a moral obligation to comply or reflects public awareness, but to the dominant political and institutional structures that allow the state to impose non-legal sanctions.
Although it is not a law, the policy includes the coercive powers of the state to comply with it. The legal instruments analysed allow us to conclude that the different prioritisation processes are partly fair and defensible, as they fulfil the elements in one way or another. In all countries, there is scope to improve their legal frameworks so that they truly match the elements. Such improvements can increase governments` accountability to publicly funded health systems. In this way, the health sector can have a clear idea of what it is related to in terms of prioritization and the public can know the reasons why certain inputs are included. The closer the prioritization mechanisms are to the integration of all elements, the more opportunities there are to increase coverage in an equitable and justifiable manner. The study of law and its impact on health is relevant to prioritization, as legal standards establish minimum standards of accountability and tools to help us understand what a country has been working on. For federal governments, standards and laws can set the criteria for prioritization at the national and local levels; For central governments, prioritization sets criteria that apply to all areas.4 Normative instruments are particularly important in the context of decentralized or fragmented health systems, as they define the basic criteria that should be taken into account when setting priorities.