Ottersen Trygve, Mbilinyi Deogratius, Maestad Ottar, Norheim Ole Frithjof
Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
Health Policy. 2008 Feb;85(2):218-27. doi: 10.1016/j.healthpol.2007.07.012. Epub 2007 Sep 7.
Maximising health as the guiding principle for resource allocation in health has been challenged by concerns about the distribution of health outcomes. There are few empirical studies that consider these potentially divergent objectives in settings of extreme resource scarcity. The aim of this study is to help fill this knowledge gap by exploring distributional preferences among health planners in Tanzania.
A deliberative group method was employed. Participants were health planners at district and regional level, selected by strategic sampling. The health planners alternated between group discussion and individual tasks. Respondents ranked health programmes with different target groups, and selected and ranked the reasons they thought should be given most importance in priority setting.
A majority consistently assigned higher rankings to programmes where the initial life expectancy of the target group was lower. A high proportion of respondents considered "affect those with least life expectancy" to be the most important reason in priority setting.
Distribution of health outcomes, in terms of life-years, matters. Specifically, the lower the initial life expectancy of the target group, the more important the programme is considered. Such preferences are compatible, within the sphere of health, with what ethicists call "prioritarianism".
将健康最大化作为卫生资源分配的指导原则受到了对健康结果分配问题的质疑。在极端资源稀缺的情况下，很少有实证研究考虑这些潜在的不同目标。本研究的目的是通过探索坦桑尼亚卫生规划者的分配偏好来填补这一知识空白。
采用了一种审议小组方法。参与者是通过战略抽样选出的地区和区域层面的卫生规划者。卫生规划者在小组讨论和个人任务之间交替进行。受访者对针对不同目标群体的卫生项目进行排名，并选择并排列他们认为在确定优先事项时应给予最重要考虑的原因。
大多数人始终将目标群体初始预期寿命较低的项目排在更高的位置。很大一部分受访者认为“影响预期寿命最短的人”是确定优先事项时最重要的原因。
就生命年而言，健康结果的分配很重要。具体而言，目标群体的初始预期寿命越低，该项目就被认为越重要。在卫生领域内，这种偏好与伦理学家所称的“优先主义”是一致的。
