Gibson Jennifer, Mitton Craig, Martin Douglas, Donaldson Cam, Singer Peter
Joint Centre for Bioethics, University of Toronto, 88 College Street, Toronto, Ontario M5G 1L4, Canada.
J Health Serv Res Policy. 2006 Jan;11(1):32-7. doi: 10.1258/135581906775094280.
Limited resources mean that decision-makers must set priorities among competing opportunities. Programme budgeting and marginal analysis (PBMA) is an economic approach that focuses on optimizing benefits with available resources. Accountability for reasonableness (A4R) is an ethics approach that focuses on ensuring fair priority-setting processes. PBMA and A4R have been used separately to provide decision-makers with advice about how to set priorities within limited resources. The goals of this research were to use the A4R framework to evaluate the fairness of using PBMA for priority setting and to assess how A4R might make PBMA fairer.
Qualitative case studies to describe priority setting using PBMA in the Calgary Health Region (Alberta, Canada) evaluated using A4R as a conceptual framework.
The use of PBMA for priority setting was fairer than previous priority setting because of its emphasis on explicit rational decision-making. However, there were opportunities to improve the process, particularly by collecting data related to the decision criteria, by developing a communication plan to engage internal and external stakeholders about priority-setting, and by providing a formal mechanism to review priority-setting decisions and resolve disputes.
There is potential for combining A4R and PBMA in a more comprehensive approach to priority setting, which uses a fair priority-setting process to reach decisions aimed at achieving optimal benefits with available resources.
资源有限意味着决策者必须在相互竞争的机会中确定优先事项。项目预算编制与边际分析（PBMA）是一种经济方法，侧重于利用可用资源优化效益。合理性问责制（A4R）是一种伦理方法，侧重于确保公平的优先事项确定过程。PBMA和A4R已被分别用于为决策者提供关于如何在有限资源内确定优先事项的建议。本研究的目的是使用A4R框架评估使用PBMA确定优先事项的公平性，并评估A4R如何使PBMA更公平。
采用定性案例研究，以A4R作为概念框架，描述加拿大艾伯塔省卡尔加里健康区域使用PBMA确定优先事项的情况。
使用PBMA确定优先事项比以前的优先事项确定方法更公平，因为它强调明确的理性决策。然而，仍有改进这一过程的机会，特别是通过收集与决策标准相关的数据，制定一项沟通计划以使内部和外部利益相关者参与优先事项确定，以及提供一个正式机制来审查优先事项确定决策并解决争议。
将A4R和PBMA结合起来用于确定优先事项的更全面方法具有潜力，该方法使用公平的优先事项确定过程来做出决策，旨在利用可用资源实现最佳效益。
