Donaldson C
Health Economics Research Unit, Aberdeen, UK.
Health Policy. 1995 Aug;33(2):79-90. doi: 10.1016/0168-8510(95)93670-v.
In this paper, a framework for using economics in health care priority setting is outlined. This framework is known as programme budgeting and marginal analysis (PBMA). Programme budgeting involves an assessment of how health care resources are currently distributed amongst programmes and within programmes. Such data can be used along with other information on local needs to decide on the main areas of change in service delivery. As resources are fixed, areas of change requiring more resources will be funded from service reductions within the same programme or within another programme. Candidates for more resources should be compared with each other and with candidates for service reduction to determine whether and what changes should go ahead. This involves 'marginal analysis' of costs and benefits of the candidates. In the paper, the problems with implementing this approach are outlined and the contribution of the other papers in the volume described.
本文概述了在医疗保健资源分配优先次序设定中运用经济学的一个框架。这个框架被称为规划预算与边际分析（PBMA）。规划预算涉及评估医疗保健资源目前在各项目之间以及项目内部是如何分配的。这些数据可与其他关于当地需求的信息一起用于决定服务提供方面的主要变革领域。由于资源是固定的，需要更多资源的变革领域将从同一项目内或另一个项目的服务削减中获得资金。应将需要更多资源的候选项目相互比较，并与服务削减的候选项目进行比较，以确定是否以及应进行哪些变革。这涉及对候选项目的成本和效益进行“边际分析”。本文概述了实施这种方法存在的问题，并介绍了该卷中其他论文的贡献。
