Johannesson M
Stockholm School of Economics, Sweden.
Health Policy. 1995 Jul;33(1):59-66. doi: 10.1016/0168-8510(94)00677-7.
It is common in cost-effectiveness analyses of health care to only include health care costs, with the argument that some fictive 'health care budget' should be used to maximize the health effects. This paper provides a criticism of the 'health care budget' approach to cost-effectiveness analysis of health care. It is argued that the approach is ad hoc and lacks theoretical foundation. The approach is also inconsistent with using a fixed budget as the decision rule for cost-effectiveness analysis. That is the case unless only costs that fall into a single annual actual budget are included in the analysis, which would mean that any cost paid by the patients should be excluded as well as any future cost changes and all costs that fall on other budgets. Furthermore the prices facing the budget holder should be used, rather than opportunity costs. It is concluded that the 'health care budget' perspective should be abandoned and the societal perspective reinstated in economic evaluation of health care.
在医疗保健的成本效益分析中，通常只纳入医疗保健成本，理由是应使用某种虚构的“医疗保健预算”来使健康效果最大化。本文对医疗保健成本效益分析中的“医疗保健预算”方法提出了批评。有人认为，该方法是临时特设的，缺乏理论基础。该方法也与将固定预算用作成本效益分析的决策规则不一致。除非分析中只纳入属于单个年度实际预算的成本，这意味着患者支付的任何成本以及未来的成本变化和所有其他预算承担的成本都应排除在外，否则情况就是如此。此外，应该使用预算持有者面临的价格，而不是机会成本。结论是，在医疗保健的经济评估中应摒弃“医疗保健预算”视角，恢复社会视角。
