González-Pier Eduardo, Gutiérrez-Delgado Cristina, Stevens Gretchen, Barraza-Lloréns Mariana, Porras-Condey Raúl, Carvalho Natalie, Loncich Kristen, Dias Rodrigo H, Kulkarni Sandeep, Casey Anna, Murakami Yuki, Ezzati Majid, Salomon Joshua A
Unidad de Análisis Económico, Secretaría de Salud, México, Paseo de la Reforma 450, PH, Col. Juárez, 06600 México, DF, México.
Salud Publica Mex. 2007;49 Suppl 1:S37-52.
Explicit priority setting presents Mexico with the opportunity to match the pressure and complexity of an advancing epidemiological transition with evidence-based policies driven by a fundamental concern for how to make the best use of scarce resources to improve population health. The Mexican priority-setting experience describes how standardised analytical approaches to decision making, mainly burden of disease and cost-effectiveness analyses, combine with other criteria -eg, being responsive to the legitimate non-health expectations of patients and ensuring fair financing across households- to design and implement a set of three differentiated health intervention packages. This process is a key element of a wider set of reform components aimed at extending health insurance, especially to the poor. The most relevant policy implications include lessons on the use of available and proven analytical tools to set national health priorities, the usefulness of priority-setting results to guide long-term capacity development, the importance of favouring an institutionalised approach to cost-effectiveness analysis, and the need for local technical capacity strengthening as an essential step to balance health-maximising arguments and other non-health criteria in a transparent and systematic process.
明确的优先事项设定为墨西哥提供了一个契机,使其能够通过基于证据的政策应对日益推进的流行病学转型所带来的压力和复杂性,这些政策的核心关注点是如何最佳利用稀缺资源来改善民众健康。墨西哥的优先事项设定经验描述了标准化的决策分析方法,主要是疾病负担分析和成本效益分析,如何与其他标准相结合,例如回应患者合理的非健康期望以及确保家庭间的公平筹资,以设计和实施一套三个不同的健康干预包。这一过程是旨在扩大医疗保险覆盖面,尤其是覆盖贫困人口的一系列更广泛改革内容的关键要素。最相关的政策启示包括关于利用现有且经过验证的分析工具来设定国家卫生优先事项的经验教训、优先事项设定结果对指导长期能力发展的有用性、支持采用制度化的成本效益分析方法的重要性,以及加强地方技术能力的必要性,这是在一个透明且系统的过程中平衡健康最大化论点和其他非健康标准的关键步骤。