以色列卫生政策制定者偏好中的效率与公平考量。
Efficiency and equity considerations in the preferences of health policy-makers in Israel.
作者信息
Shmueli Amir, Golan Ofra, Paolucci Francesco, Mentzakis Emmanouil
机构信息
Department of Health Management, The Hebrew University-Hadassah School of Public Health, POB 12272, Jerusalem, 91120 Israel.
The Center for Academic Studies, Or Yehuda, Israel.
出版信息
Isr J Health Policy Res. 2017 Apr 1;6:18. doi: 10.1186/s13584-017-0142-7. eCollection 2017.
BACKGROUND
There is a traditional tension in public policy between the maximization of welfare from given resources (efficiency) and considerations related to the distribution of welfare among the population and to social justice (equity). The aim of this paper is to measure the relative weights of the efficiency- and equity-enhancing criteria in the preferences of health policy-makers in Israel, and to compare the Israeli results with those of other countries.
METHODS
We used the criteria of efficiency and equity which were adopted in a previous international study, adapted to Israel. The equity criteria, as defined in the international study, are: severity of the disease, age (young vs. elderly), and the extent to which the poor are subsidized. Efficiency is represented by the criteria: the potential number of beneficiaries, the extent of the health benefits to the patient, and the results of economic assessments (cost per QALY gained). We contacted 147 policy-makers, 65 of whom completed the survey (a response rate of 44%). Using Discrete Choice Experiment (DCE) methodology by 1000Minds software, we estimated the relative weights of these seven criteria, and predicted the desirability of technologies characterized by profiles of the criteria.
RESULTS
The overall weight attached to the four efficiency criteria was 46% and that of the three equity criteria was 54%. The most important criteria were "financing of the technology is required so that the poor will be able to receive it" and the level of individual benefit. "The technology is intended to be used by the elderly" criterion appeared as the least important, taking the seventh place. Policy-makers who had experience as members of the Basket Committee appear to prefer efficiency criteria more than those who had never participated in the Basket Committee deliberations. While the efficiency consideration gained preference in most countries studied, Israel is unique in its balance between the weights attached to equity and efficiency considerations by health policy-makers.
DISCUSSION
The study explored the trade-off between efficiency and equity considerations in the preferences of health policy-makers in Israel. The way these declarative preferences have been expressed in actual policy decisions remains to be explored.
背景
在公共政策中，在利用既定资源实现福利最大化（效率）与关乎人群福利分配及社会正义（公平）的考量之间，一直存在传统的张力。本文旨在衡量以色列卫生政策制定者偏好中提高效率和公平标准的相对权重，并将以色列的结果与其他国家的结果进行比较。
方法
我们采用了先前一项国际研究中采用的、适用于以色列的效率和公平标准。国际研究中定义的公平标准为：疾病严重程度、年龄（年轻人与老年人）以及穷人获得补贴的程度。效率由以下标准体现：潜在受益人数、对患者的健康益处程度以及经济评估结果（每获得一个质量调整生命年的成本）。我们联系了147名政策制定者，其中65人完成了调查（回复率为44%）。使用1000Minds软件的离散选择实验（DCE）方法，我们估计了这七个标准的相对权重，并预测了具有这些标准特征的技术的可取性。
结果
四个效率标准的总体权重为46%，三个公平标准的总体权重为54%。最重要的标准是“需要为该技术提供资金，以便穷人能够获得它”和个人受益水平。“该技术旨在供老年人使用”这一标准似乎最不重要，排在第七位。有担任篮子委员会成员经验的政策制定者似乎比那些从未参与篮子委员会审议的人更倾向于效率标准。虽然在大多数所研究的国家中效率考量更受青睐，但以色列在卫生政策制定者对公平和效率考量所赋予的权重之间的平衡方面独具特色。
讨论
该研究探讨了以色列卫生政策制定者偏好中效率与公平考量之间的权衡。这些声明性偏好如何在实际政策决策中得以体现仍有待探索。
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