Table 8 Using local evidence to assess the likely impacts of options (i.e. the existence of modifying factors) and to identify barriers to implementing options

In Argentina, an evaluation was conducted of a regulation related to payments for obesity treatments, such as bariatric surgery. A national survey of cardiovascular risk factors was used to assess the extent to which obesity was a national problem. This survey provided data on the proportion of people who were overweight or obese and could therefore be used to assess the likely impacts of making different forms of obesity treatment available. (This survey is available at: http://www.msal.gov.ar/htm/Site/enfr/resultados_completos.asp)

Canadian stakeholders participating in a deliberative dialogue about how to improve access to primary healthcare in Canada considered a variety of options. All of these included some form of transition from care which was physician-led to care which was team-led. An evidence brief, drawing on local evidence, was prepared to inform the dialogue. This identified four potential barriers to the implementation of the options:

1. Initial wariness among some patients of potential disruptions to their relationship with their primary healthcare physician

2. Wariness on the part of physicians of potential infringements on their professional and commercial autonomy, in the light of the private delivery component of the 'private delivery/public payment' arrangement with physicians

3. A potential lack of viability in terms of organisational scale in many rural and remote communities, and

4. Government willingness to extend public payment to other healthcare providers and teams while at the same time maintaining the existing public payment to physicians, as part of the 'private delivery/public payment' arrangement with physicians. This was considered to be a particular concern during a recession [44]