Poche Centre for Indigenous Health, Sydney Medical School, Edward Ford Building A27 the University of Sydney, 2006, NSW Sydney, Australia.
Int J Equity Health. 2014 Jun 7;13:45. doi: 10.1186/1475-9276-13-45.
The health of Indigenous Australians is worse than that of other Australians. Most of the determinants of health are preventable and the poor health outcomes are inequitable. The Australian Government recently pledged to close that health gap. One possible way is to improve the priority setting process to ensure transparency and the use of evidence such as epidemiology, equity and economic evaluation.The purpose of this research was to elicit the perceptions of Indigenous and non-Indigenous decision-makers on several issues related to priority setting in Indigenous-specific health care services. Specifically, we aimed to:1. identify the criteria used to set priorities in Indigenous-specific health care services;2. determine the level of uptake of economic evaluation evidence by decision-makers and how to improve its uptake; and 3. identify how the priority setting process can be improved from the perspective of decision-makers.
We used a paper survey instrument, adapted from Mitton and colleagues' work, and a face-to-face interview approach to elicit decision-makers' perceptions in Indigenous-specific health care in Victoria, Australia. We used mixed methods to analyse data from the survey. Responses were summarised using descriptive statistics and content analysis. Results were reported as numbers and percentages.
The size of the health burden; sustainability and acceptability of interventions; historical trends/patterns; and efficiency are key criteria for making choices in Indigenous health in Victoria. There is a need for an explicit priority setting approach, which is systematic, and is able to use available data/evidence, such as economic evaluation evidence. The involvement of Indigenous Australians in the process would potentially make the process acceptable.
An economic approach to priority setting is a potentially acceptable and useful tool for Aboriginal Community Controlled Health Services (ACCHS). It has the ability to use evidence and ensure due process at the same time. The use of evidence can ensure that health outcomes for Indigenous peoples can be maximised - hence, increase the potential for 'closing the gap' between Indigenous and other Australians.
澳大利亚原住民的健康状况比其他澳大利亚人差。大多数健康决定因素是可以预防的，而较差的健康结果是不公平的。澳大利亚政府最近承诺缩小这一健康差距。一种可能的方法是改进优先级设置过程，以确保透明度和使用证据，如流行病学、公平和经济评估。本研究旨在了解原住民和非原住民决策者对与原住民特定医疗服务优先级设置相关的几个问题的看法。具体来说，我们旨在：1. 确定用于设定原住民特定医疗服务优先级的标准；2. 确定决策者对经济评估证据的接受程度及其提高接受程度的方法；3. 从决策者的角度确定如何改进优先级设置过程。
我们使用了一种源自 Mitton 及其同事工作的纸质调查工具和面对面访谈方法，在澳大利亚维多利亚州的原住民特定医疗保健中征求决策者的意见。我们使用混合方法分析调查数据。使用描述性统计和内容分析来总结调查结果。结果以数字和百分比报告。
在维多利亚州，健康负担的大小；干预措施的可持续性和可接受性；历史趋势/模式；以及效率是在原住民健康中做出选择的关键标准。需要有一种明确的、系统的、能够使用现有数据/证据（如经济评估证据）的优先级设置方法。原住民的参与有可能使该过程被接受。
优先考虑经济方法是原住民社区控制的医疗服务（ACCHS）的一种潜在可接受和有用的工具。它有能力同时使用证据和确保适当的程序。证据的使用可以确保原住民的健康结果得到最大化——从而增加原住民和其他澳大利亚人之间“缩小差距”的潜力。
