Shmueli Amir
The Hebrew University-Hadassah School of Public Health, Jerusalem, Israel.
Isr J Health Policy Res. 2017 Apr 30;6:20. doi: 10.1186/s13584-017-0145-4. eCollection 2017.
Prioritization of medical technologies requires a multi-dimensional view. Often, conflicting equity and efficiency criteria should be reconciled. The most dramatic manifestation of such conflict is in the prioritization of new medical technologies asking for public finance performed yearly by the Israeli Basket Committee. The aim of this paper is to compare the revealed preferences of the 2006/7 Basket Committee's members with the declared preferences of health policy-makers in Israel.
We compared the ranking of a sample of 18 accepted and 16 rejected technologies evaluated by the 2006/7 Basket Committee with the ranking of these technologies as predicted based on the preferences of Israeli health policy-makers. These preferences were elicited by a recent Discrete Choice Experiment (DCE) which estimated the relative weights of four equity and three efficiency criteria. The candidate technologies were characterized by these seven criteria, and their ranking was determined. A third comparative ranking of these technologies was the efficiency ranking, which is based on international data on cost per QALY gained.
The Committee's ranking of all technologies show no correspondence with the policy-makers' ranking. The correlation between the two is negative when only accepted technologies are ranked. The Committee's ranking is positively correlated with the efficiency ranking, while the health policy-makers' ranking is not.
The Committee appeared to assign to efficiency considerations a higher weight than assigned by health policy-makers. The main explanation is that while policy-makers' ranking is based on stated preferences, that of the Committee reflects revealed preferences. Real life prioritization, made under a budget constraint, enhances the importance of efficiency considerations at the expense of equity ones.
In order for Israeli health policy to be consistent and well coordinated across policy-makers, some discussions and exchanges are needed, to arrive at a common set of preferences with respect to equity and efficiency considerations.
医疗技术的优先排序需要多维度视角。通常，相互冲突的公平性和效率标准需要协调。这种冲突最显著的表现在于以色列药品报销目录委员会每年对需要公共资金的新医疗技术进行的优先排序。本文旨在比较2006/7年度药品报销目录委员会成员所显示的偏好与以色列卫生政策制定者所宣称的偏好。
我们将2006/7年度药品报销目录委员会评估的18种被接受技术和16种被拒绝技术的样本排名，与基于以色列卫生政策制定者偏好预测的这些技术的排名进行了比较。这些偏好是通过最近的一项离散选择实验（DCE）得出的，该实验估计了四个公平性标准和三个效率标准的相对权重。候选技术由这七个标准进行特征描述，并确定其排名。这些技术的第三个比较排名是效率排名，它基于每获得一个质量调整生命年（QALY）的成本的国际数据。
委员会对所有技术的排名与政策制定者的排名不相符。仅对被接受技术进行排名时，两者之间的相关性为负。委员会的排名与效率排名呈正相关，而卫生政策制定者的排名则不然。
委员会似乎赋予效率考量的权重高于卫生政策制定者。主要解释是，虽然政策制定者的排名基于陈述的偏好，但委员会的排名反映的是显示的偏好。在预算限制下进行的实际生活中的优先排序，提高了效率考量的重要性，而牺牲了公平性考量。
为使以色列卫生政策在政策制定者之间保持一致且协调良好，需要进行一些讨论和交流，以就公平性和效率考量达成一套共同的偏好。
