Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, BC, Canada.
Expert Rev Pharmacoecon Outcomes Res. 2010 Oct;10(5):539-52. doi: 10.1586/erp.10.66.
Economists' approaches to priority setting focus on the principles of opportunity cost, marginal analysis and choice under scarcity. These approaches are based on the premise that it is possible to design a rational priority setting system that will produce legitimate changes in resource allocation. However, beyond issuing guidance at the national level, economic approaches to priority setting have had only a moderate impact in practice. In particular, local health service organizations - such as health authorities, health maintenance organizations, hospitals and healthcare trusts - have had difficulty implementing evidence from economic appraisals. Yet, in the context of making decisions between competing claims on scarce health service resources, economic tools and thinking have much to offer. The purpose of this article is to describe and discuss ten evidence-based guidelines for the successful design and implementation of a program budgeting and marginal analysis (PBMA) priority setting exercise. PBMA is a framework that explicitly recognizes the need to balance pragmatic and ethical considerations with economic rationality when making resource allocation decisions. While the ten guidelines are drawn from the PBMA framework, they may be generalized across a range of economic approaches to priority setting.
经济学家在制定优先事项时所采用的方法侧重于机会成本、边际分析和稀缺条件下的选择原则。这些方法的前提是,有可能设计出一个理性的优先事项制定系统,从而在资源配置方面产生合理的变化。然而,除了在国家层面提供指导之外,经济方法在实践中的影响也只是适度的。特别是在地方卫生服务组织(如卫生当局、健康维护组织、医院和医疗信托)方面,在实施经济评估证据方面存在困难。然而,在对稀缺卫生服务资源的竞争主张进行决策时,经济工具和思维方式有很大的帮助。本文的目的是描述和讨论成功设计和实施方案预算编制和边际分析(PBMA)优先事项制定工作的十个基于证据的指南。PBMA 是一个框架,在做出资源分配决策时,明确认识到需要平衡务实和伦理考虑与经济合理性。虽然这十个指南是从 PBMA 框架中得出的,但它们可以推广到一系列经济优先事项制定方法中。