School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
School of Public Health, University of Alberta, Edmonton, Canada.
Eur J Health Econ. 2018 May;19(4):489-498. doi: 10.1007/s10198-017-0897-3. Epub 2017 Jun 1.
In publicly funded health care systems, decision makers must continually balance often conflicting priorities of efficiency and equity. Health economists have developed a set of highly sophisticated analytical methods for assessing efficiency, but less attention has been paid to formally incorporating equity considerations into analyses. As a result, where equity is considered is often informal, ad hoc and/or simplistic. This paper is a proposal for a mechanism for formally incorporating equity within the decision process. It begins with an overview of the current literature on equity weighting. It then considers the case of a single equity domain and illustrates how this is currently applied in practice by the UK's National Institute for Health and Care Excellence. It then proposes a more comprehensive method for considering the multi-attribute equity state, where a population exhibits more than one trait considered worthy of differential weighting. Finally, the paper proposes a mechanism by which this could be applied in practice, and concludes with a discussion of the challenges for applying multi-attribute equity weighting.
在公共资助的医疗保健系统中，决策者必须不断平衡效率和公平这两个常常相互冲突的优先事项。卫生经济学家已经开发出了一系列用于评估效率的高度复杂的分析方法，但对将公平因素正式纳入分析的关注较少。因此，在考虑公平性的地方，往往是非正式的、临时的和/或简单的。本文提出了一种在决策过程中正式纳入公平性的机制。它首先概述了当前关于公平权重的文献。然后考虑了单一公平领域的情况，并说明了英国国家卫生与保健卓越研究所目前如何在实践中应用这一情况。然后提出了一种更全面的方法来考虑多属性公平状态，即一个群体表现出一种以上值得差异化加权的特征。最后，本文提出了一种在实践中应用这种方法的机制，并讨论了应用多属性公平权重的挑战。
