Lozano Rafael, Soliz Patricia, Gakidou Emmanuela, Abbott-Klafter Jesse, Feehan Dennis M, Vidal Cecilia, Ortiz Juan Pablo, Murray Christopher J L
Secretaría de Salud, Reforma 450 Col Juarez CP 06600, Mexico DF, Mexico.
Lancet. 2006 Nov 11;368(9548):1729-41. doi: 10.1016/S0140-6736(06)69566-4.
Benchmarking of the performance of states, provinces, or districts in a decentralised health system is important for fostering of accountability, monitoring of progress, identification of determinants of success and failure, and creation of a culture of evidence. The Mexican Ministry of Health has, since 2001, used a benchmarking approach based on the WHO concept of effective coverage of an intervention, which is defined as the proportion of potential health gain that could be delivered by the health system to that which is actually delivered. Using data collection systems, including state representative examination surveys, vital registration, and hospital discharge registries, we have monitored the delivery of 14 interventions for 2005-06. Overall effective coverage ranges from 54.0% in Chiapas, a poor state, to 65.1% in the Federal District. Effective coverage for maternal and child health interventions is substantially higher than that for interventions that target other health problems. Effective coverage for the lowest wealth quintile is 52% compared with 61% for the highest quintile. Effective coverage is closely related to public-health spending per head across states; this relation is stronger for interventions that are not related to maternal and child health than those for maternal and child health. Considerable variation also exists in effective coverage at similar amounts of spending. We discuss the implications of these issues for the further development of the Mexican health-information system. Benchmarking of performance by measuring effective coverage encourages decision-makers to focus on quality service provision, not only service availability. The effective coverage calculation is an important device for health-system stewardship. In adopting this approach, other countries should select interventions to be measured on the basis of the criteria of affordability, effect on population health, effect on health inequalities, and capacity to measure the effects of the intervention. The national institutions undertaking this benchmarking must have the mandate, skills, resources, and independence to succeed.
在分权式卫生系统中，对各个州、省或地区的绩效进行基准评估，对于加强问责制、监测进展情况、确定成败的决定因素以及营造注重证据的文化至关重要。自2001年以来，墨西哥卫生部采用了一种基于世界卫生组织干预措施有效覆盖率概念的基准评估方法，有效覆盖率的定义是卫生系统能够提供的潜在健康收益与实际提供的健康收益之比。通过使用数据收集系统，包括州代表性检查调查、生命登记和医院出院登记，我们监测了2005 - 2006年期间14项干预措施的实施情况。总体有效覆盖率从贫困州恰帕斯州的54.0%到联邦区的65.1%不等。母婴健康干预措施的有效覆盖率显著高于针对其他健康问题的干预措施。最贫困五分位数人群的有效覆盖率为52%，而最富裕五分位数人群为61%。有效覆盖率与各州人均公共卫生支出密切相关；与母婴健康无关的干预措施的这种关系比母婴健康干预措施更强。在支出水平相似的情况下，有效覆盖率也存在很大差异。我们讨论了这些问题对墨西哥卫生信息系统进一步发展的影响。通过衡量有效覆盖率进行绩效基准评估，鼓励决策者不仅关注服务的可获得性，还要关注优质服务的提供。有效覆盖率计算是卫生系统管理的一项重要手段。在采用这种方法时，其他国家应根据可承受性、对人群健康的影响、对健康不平等的影响以及衡量干预措施效果的能力等标准来选择要衡量的干预措施进行评估。进行这种基准评估的国家机构必须具备成功所需的授权、技能、资源和独立性。
