Centre for Health Policy, Programs and Economics, School of Population Health, The University of Melbourne, Carlton, Victoria 3010, Australia.
BMC Health Serv Res. 2012 Sep 7;12:307. doi: 10.1186/1472-6963-12-307.
Health economics is increasingly used to inform resource allocation decision-making, however, there is comparatively little evidence relevant to minority groups. In part, this is due to lack of cost and effectiveness data specific to these groups upon which economic evaluations can be based. Consequently, resource allocation decisions often rely on mainstream evidence which may not be representative, resulting in inequitable funding decisions. This paper describes a method to overcome this deficiency for Australia's Indigenous population. A template has been developed which can adapt mainstream health intervention data to the Indigenous setting.
The 'Indigenous Health Service Delivery Template' has been constructed using mixed methods, which include literature review, stakeholder discussions and key informant interviews. The template quantifies the differences in intervention delivery between best practice primary health care for the Indigenous population via Aboriginal Community Controlled Health Services (ACCHSs), and mainstream general practitioner (GP) practices. Differences in costs and outcomes have been identified, measured and valued. This template can then be used to adapt mainstream health intervention data to allow its economic evaluation as if delivered from an ACCHS.
The template indicates that more resources are required in the delivery of health interventions via ACCHSs, due to their comprehensive nature. As a result, the costs of such interventions are greater, however this is accompanied by greater benefits due to improved health service access. In the example case of the polypill intervention, 58% more costs were involved in delivery via ACCHSs, with 50% more benefits. Cost-effectiveness ratios were also altered accordingly.
The Indigenous Health Service Delivery Template reveals significant differences in the way health interventions are delivered from ACCHSs compared to mainstream GP practices. It is important that these differences are included in the conduct of economic evaluations to ensure results are relevant to Indigenous Australians. Similar techniques would be generalisable to other disadvantaged minority populations. This will allow resource allocation decision-makers access to economic evidence that more accurately represents the needs and context of disadvantaged groups, which is particularly important if addressing health inequities is a stated goal.
健康经济学越来越多地用于为资源分配决策提供信息，但与少数群体相关的证据相对较少。部分原因是缺乏可用于经济评估的针对这些群体的特定成本和效果数据。因此，资源分配决策往往依赖于可能不具有代表性的主流证据，从而导致不公平的资金决策。本文描述了一种克服澳大利亚土著居民这一缺陷的方法。已经开发出一个模板，可以将主流卫生干预数据适用于土著环境。
使用混合方法构建了“土著卫生服务提供模板”，其中包括文献综述、利益相关者讨论和关键知情人访谈。该模板量化了通过土著社区控制的卫生服务（ACCHS）为土著人口提供最佳实践初级卫生保健与主流全科医生（GP）实践之间在干预措施提供方面的差异。已经确定、衡量和评估了差异的成本和结果。然后，可以使用此模板来调整主流卫生干预措施的数据，以允许其从 ACCHS 进行经济评估。
模板表明，由于其综合性，通过 ACCHS 提供卫生干预措施需要更多的资源。因此，此类干预措施的成本更高，但由于改善了卫生服务的可及性，因此也带来了更大的收益。在多酚丸干预的示例案例中，通过 ACCHS 进行交付涉及 58%的成本增加，而收益增加 50%。成本效益比也相应改变。
土著卫生服务提供模板揭示了通过 ACCHS 与主流 GP 实践相比，卫生干预措施的提供方式存在重大差异。在进行经济评估时，重要的是要包括这些差异，以确保结果与澳大利亚土著居民相关。类似的技术也可以推广到其他弱势少数群体。这将使资源分配决策者能够获得更准确地代表弱势群体需求和背景的经济证据，这在解决健康不平等问题是既定目标的情况下尤为重要。
