Mitton Craig, Patten San, Waldner Howard, Donaldson Cam
Centre for Health and Policy Studies, University of Calgary, 3330 Hospital Dr. N.W., T2N 4N1 Calgary, Alta, Canada.
Soc Sci Med. 2003 Nov;57(9):1653-63. doi: 10.1016/s0277-9536(02)00549-x.
As resources in health care are scarce, health authorities and other health organizations are charged with determining how best to spend limited resources. While a number of formal approaches to priority setting within health authorities have been used internationally, there has been limited success with such activity, particularly across major service portfolios. This participatory action research project instituted a novel priority setting framework, coined macro-marginal analysis (MMA), in a fully integrated urban health region in Alberta, Canada. The focus of MMA is on identifying areas for service growth and areas for resource release, then determining, based on pre-defined, locally generated criteria, if actual shifts or re-allocation of resources should occur. For fiscal year 2002/03, the Calgary Health Region identified over 40 M dollars in resource releases (approximately 3% of the total budget), which were made available for servicing the deficit, and more importantly for our purposes, re-investing in service growth areas. The MMA framework is pragmatic in nature and has the ability to incorporate relevant evidence directly into the decision-making process. This work constitutes a significant advancement in health economics, and responds where previous priority setting approaches have failed in that it allows decision-makers to achieve genuine re-allocation of resources with the aim of improving population health or better meeting other important criteria.
由于医疗保健资源稀缺，卫生当局和其他卫生组织负责确定如何以最佳方式使用有限的资源。虽然国际上已采用多种在卫生当局内确定优先事项的正式方法，但此类活动取得的成功有限，尤其是在主要服务组合方面。这个参与式行动研究项目在加拿大艾伯塔省一个完全整合的城市卫生区域建立了一个新的确定优先事项框架，即宏观边际分析（MMA）。MMA的重点是确定服务增长领域和资源释放领域，然后根据预先定义的、本地制定的标准，决定是否应实际转移或重新分配资源。在2002/03财政年度，卡尔加里卫生区域确定了超过4000万美元的资源释放（约占总预算的3%），这些资金可用于弥补赤字，更重要的是，对我们而言，可用于对服务增长领域进行再投资。MMA框架本质上很务实，能够将相关证据直接纳入决策过程。这项工作是卫生经济学的一项重大进展，回应了以往确定优先事项方法失败的地方，因为它使决策者能够真正重新分配资源，以改善人群健康或更好地满足其他重要标准。
