Chalkidou Kalipso, Culyer Anthony J, Glassman Amanda, Li Ryan
Global Health and Development Group, Institute of Global Health Innovation, Imperial College London, London, SW7 2AZ, UK.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, M5T 3M6, Canada.
F1000Res. 2017 Jul 25;6:1223. doi: 10.12688/f1000research.11863.1. eCollection 2017.
With aid budgets shrinking in richer countries and more money for healthcare becoming available from domestic sources in poorer ones, the rhetoric of value for money or improved efficiency of aid spending is increasing. Taking healthcare as one example, we discuss the need for and potential benefits of (and obstacles to) the establishment of a national institute for aid effectiveness. In the case of the UK, such an institute would help improve development spending decisions made by DFID, the country's aid agency, as well as by the various multilaterals, such as the Global Fund, through which British aid monies is channelled. It could and should also help countries becoming increasingly independent from aid build their own capacity to make sure their own resources go further in terms of health outcomes and more equitable distribution. Such an undertaking will not be easy given deep suspicion amongst development experts towards economists and arguments for improving efficiency. We argue that it is exactly needs matter that those who make spending decisions must consider the needs not being met when a priority requires that finite resources are diverted elsewhere. These chosen unmet needs are the true costs; they are lost health. They be considered, and should be minimised and must therefore be measured. Such exposition of the trade-offs of competing investment options can help inform an array of old and newer development tools, from strategic purchasing and pricing negotiations for healthcare products to performance based contracts and innovative financing tools for programmatic interventions.
随着富裕国家的援助预算不断缩减，而贫穷国家国内用于医疗保健的资金日益增多，有关援助资金的资金价值或提高援助效率的言论也越来越多。以医疗保健为例，我们讨论建立一个国家援助实效研究所的必要性、潜在益处（以及障碍）。就英国而言，这样一个研究所将有助于改善由该国援助机构国际发展部（DFID）以及诸如全球基金等各种多边机构做出的发展支出决策，英国的援助资金就是通过这些多边机构进行分配的。它能够而且也应该帮助那些日益摆脱援助的国家建设自身能力，以确保其自身资源在健康成果和更公平分配方面能发挥更大作用。鉴于发展专家对经济学家以及提高效率的观点存在深深的怀疑，这样一项事业并非易事。我们认为，当一项优先事项要求将有限资源转用于其他方面时，做出支出决策的人必须考虑那些未得到满足的需求，这一点至关重要。这些被选定的未得到满足的需求才是真正的成本；它们是失去的健康。这些成本必须得到考虑，应该被最小化，因此必须加以衡量。对相互竞争的投资选项之间权衡取舍的这种阐述，有助于为一系列新旧发展工具提供信息，从医疗保健产品的战略采购和定价谈判到基于绩效的合同以及用于方案干预的创新融资工具。
