Menon Devidas, Stafinski Tania, Martin Douglas
Health Policy and Management Program, Department of Public Health Sciences, 10-126 Clinical Sciences Building, University of Alberta, Edmonton, Alberta T6G 2G3, Canada.
Health Policy. 2007 Dec;84(2-3):220-33. doi: 10.1016/j.healthpol.2007.05.009. Epub 2007 Jul 12.
In recent years, heightened public awareness of new medical advances that offer improved therapeutic and diagnostic options coupled with increased fiscal pressure on health care systems to deliver both equitable and efficient care have magnified the need to examine carefully how and by whom health care priorities are set.
To assess processes for setting health care priorities in Alberta, Canada.
A demographically representative sample of senior management within Regional Health Authorities (RHAs) and specialized provincial boards was selected to participate in key informant interviews. The interviews, which were audio-taped and transcribed, comprised open-ended questions addressing priority-setting approaches employed and the extent to which the public was involved. Through a series of iterations, transcripts were analyzed using content analytic techniques.
In general, priority-setting was found to involve four steps: (1) identification of health care needs, (2) allocation of resources, (3) communication of decisions to stakeholders, and (4) management of feedback from them. While approaches to accomplishing each step varied across RHAs and specialized provincial bodies, public involvement did not. In all cases, mechanisms for engaging them in priority-setting focused almost exclusively on the first step. From an "accountability for reasonableness" perspective, none of the organizations surveyed had established processes that met all four principles.
近年来，公众对能提供更好治疗和诊断选择的新医学进展的关注度不断提高，同时医疗保健系统在提供公平且高效的医疗服务方面面临着越来越大的财政压力，这使得仔细审视医疗保健优先事项如何确定以及由谁来确定的必要性更加凸显。
评估加拿大艾伯塔省确定医疗保健优先事项的过程。
从区域卫生当局（RHAs）和省级专业委员会中选取了具有人口统计学代表性的高级管理人员样本，参与关键信息人访谈。访谈进行了录音和转录，包括一些开放式问题，涉及所采用的优先事项确定方法以及公众参与的程度。通过一系列反复过程，使用内容分析技术对转录文本进行分析。
总体而言，确定优先事项的过程包括四个步骤：（1）确定医疗保健需求，（2）分配资源，（3）向利益相关者传达决策，以及（4）管理来自他们的反馈。虽然各区域卫生当局和省级专业机构完成每个步骤的方法各不相同，但公众参与情况并非如此。在所有情况下，让公众参与优先事项确定的机制几乎完全集中在第一步。从“合理性问责”的角度来看，接受调查的组织中没有一个建立了符合所有四项原则的流程。
