Price Christopher P, Wolstenholme Jane, McGinley Patrick, St John Andrew
1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
2 Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Health Serv Manage Res. 2018 Feb;31(1):43-50. doi: 10.1177/0951484817736727. Epub 2017 Oct 31.
Adoption of new technologies, including diagnostic tests, is often considered not to deliver the expected return on investment. The reasons for this poor link between expectation and outcome include lack of evidence, variation in use of the technology, and an inability of the health system to manage the balance between investment and disinvestment associated with the change in care pathway. The challenges lie in the complex nature of healthcare provision where the investment is likely to be made in the jurisdiction of one stakeholder while the benefits (as well as dis-benefits) accrue to the other stakeholders. A prime example is found in the field of laboratory medicine and the use of diagnostic tests. The current economic tools employed in healthcare are primarily used to make policy and strategic decisions, particularly across health systems, and in purchaser and provider domains. These tools primarily involve cost effectiveness and budget impact analyses, both of which have been applied in health technology assessment of diagnostic technologies. However, they lack the granularity to translate findings down to the financial management and operational decision making at the provider department level. We propose an approach to translational health economics based on information derived from service line management and time-driven activity-based costing, identifying the resource utilisation for each of the units involved in the delivery of a care pathway, before and after adoption of new technology. This will inform investment and disinvestment decisions, along with identifying where the benefits, and dis-benefits, can be achieved for all stakeholders.
包括诊断测试在内的新技术采用，往往被认为无法带来预期的投资回报。期望与结果之间联系不佳的原因包括缺乏证据、技术使用的差异，以及卫生系统无法管理与护理路径变化相关的投资与撤资之间的平衡。挑战在于医疗保健服务的复杂性，投资可能由一个利益相关者在其管辖范围内进行，而收益（以及不利因素）却归于其他利益相关者。一个典型的例子见于检验医学领域和诊断测试的使用。目前医疗保健中使用的经济工具主要用于制定政策和战略决策，特别是在整个卫生系统以及购买方和提供方领域。这些工具主要涉及成本效益分析和预算影响分析，两者都已应用于诊断技术的卫生技术评估。然而，它们缺乏将结果细化到提供方部门层面的财务管理和运营决策的粒度。我们提出一种基于服务线管理和时间驱动作业成本法得出的信息的转化卫生经济学方法，在采用新技术之前和之后，确定护理路径交付过程中每个单元的资源利用情况。这将为投资和撤资决策提供信息，同时确定所有利益相关者在何处能够实现收益和不利因素。
