Prosser L A, Koplan J P, Neumann P J, Weinstein M C
Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115-5924, USA.
Am J Manag Care. 2000 Feb;6(2):173-9.
Managed care organizations would appear to be natural advocates for, and users of, cost-effectiveness analysis (CEA) as a tool for maximizing health outcomes for their covered populations within fixed budgets. There is, however, little evidence that CEA plays a major role in managed care decision making. The purpose of this paper is to identify barriers to both conducting and using CEA in managed care decision making. Lack of understanding about the value and applicability of CEA, and incentives that do not align with a lifetime perspective on either health outcomes or costs may be at least as important as perceived or real methodological limitations of the methodology. Research focused on ways to overcome these barriers, and thereby improve resource allocations, is recommended.
管理式医疗组织似乎自然而然地会倡导并使用成本效益分析（CEA），将其作为一种在固定预算范围内为其参保人群实现健康结果最大化的工具。然而，几乎没有证据表明CEA在管理式医疗决策中发挥着主要作用。本文的目的是确定在管理式医疗决策中进行和使用CEA的障碍。对CEA的价值和适用性缺乏了解，以及与健康结果或成本的终身视角不一致的激励措施，可能至少与该方法在认知上或实际存在的方法局限性同样重要。建议开展研究，聚焦于克服这些障碍的方法，从而改善资源分配。
