Hauck Katharina, Shaw Rebecca, Smith Peter C
Centre for Health Economics, University of York, UK.
Health Econ. 2002 Dec;11(8):667-77. doi: 10.1002/hec.692.
Traditionally, most health care systems which pretend to any sort of rationality and cost control have sought to allocate their limited funds in order to secure equal opportunity of access for equal need. The UK government is implementing a fundamental change of resource allocation philosophy towards 'contributing to the reduction of avoidable health inequalities'. The purpose of this essay is to explore some of the economic issues that arise when seeking to allocate health care resources according to the new criterion. It indicates that health inequalities might arise because of variations in the quality of health services, variations in access to those services, or variations in the way people produce health, and that the resource allocation consequences differ depending on which source is being addressed. The paper shows that an objective of reducing health inequalities is not necessarily compatible with an objective of equity of access, nor with the objective of maximising health gain. The results have profound consequences for approaches towards economic evaluation, the role of clinical guidelines and performance management, as well as for resource allocation methods.
传统上，大多数自称具有某种合理性和成本控制能力的医疗保健系统都试图分配其有限的资金，以确保在同等需求下享有平等的就医机会。英国政府正在对资源分配理念进行根本性转变，转向“有助于减少可避免的健康不平等现象”。本文的目的是探讨在试图根据新的标准分配医疗保健资源时出现的一些经济问题。它表明，健康不平等现象可能是由于卫生服务质量的差异、获得这些服务的机会差异，或者人们产生健康的方式差异而产生的，而且资源分配的后果因所解决的根源不同而有所差异。该论文表明，减少健康不平等的目标不一定与就医机会公平的目标兼容，也不一定与使健康收益最大化的目标兼容。这些结果对经济评估方法、临床指南和绩效管理的作用以及资源分配方法都产生了深远的影响。
