Political Economy and Health Economics, Faculty of Social Sciences, Université de Liège, Liège, Belgium.
School of Public Health, Université libre de Bruxelles, Brussels, Belgium.
Glob Health Sci Pract. 2018 Jun 29;6(2):260-271. doi: 10.9745/GHSP-D-18-00001. Print 2018 Jun 27.
Many countries rely on standard recipes for accelerating progress toward universal health coverage (UHC). With limited generalizable empirical evidence, expert confidence and consensus plays a major role in shaping country policy choices. This article presents an exploratory attempt conducted between April and September 2016 to measure confidence and consensus among a panel of global health experts in terms of the effectiveness and feasibility of a number of policy options commonly proposed for achieving UHC in low- and middle-income countries, such as fee exemptions for certain groups of people, ring-fenced domestic health budgets, and public-private partnerships. To ensure a relative homogeneity of contexts, we focused on French-speaking sub-Saharan Africa. We initially used the Delphi method to arrive at expert consensus, but since no consensus emerged after 2 rounds, we adjusted our approach to a statistical analysis of the results from our questionnaire by measuring the degree of consensus on each policy option through 100 (signifying total consensus) minus the size of the interquartile range of the individual scores. Seventeen global health experts from various backgrounds, but with at least 20 years' experience in the broad region, participated in the 2 rounds of the study. The results provide an initial "mapping" of the opinions of a group of experts and suggest interesting lessons. For the 18 policy options proposed, consensus emerged only on strengthening the supply of quality primary health care services (judged as being effective with a confidence score of 79 and consensus score of 90), and on fee exemptions for the poorest (judged as being fairly easy to implement with a confidence score of 66 and consensus score of 85). For none of the 18 common policy options was there consensus on both potential effectiveness and feasibility, with very diverging opinions concerning 5 policy options. The lack of confidence and consensus within the panel seems to reflect the lack of consistent evidence on the proposed policy options. This suggests that experts' opinions should be framed within strengthened inclusive and "evidence-informed deliberative processes" where the trade-offs along the 3 dimensions of UHC-extending the population covered against health hazards, expanding the range of services and benefits covered, and reducing out-of-pocket expenditures-can be discussed in a transparent and contextualized setting.
许多国家依赖标准处方来加速实现全民健康覆盖（UHC）。由于经验有限，专家的信心和共识在塑造国家政策选择方面发挥着重要作用。本文介绍了 2016 年 4 月至 9 月期间进行的一项探索性尝试，以衡量一组全球卫生专家对一系列常见政策选择的有效性和可行性的信心和共识，这些政策选择通常用于实现中低收入国家的 UHC，例如为某些人群免除费用、为国内卫生预算设定上限以及公私伙伴关系。为了确保上下文的相对同质性，我们专注于撒哈拉以南的法语国家。我们最初使用 Delphi 方法达成专家共识，但由于两轮后没有达成共识，我们调整了方法，通过对每个政策选择的 100 分（表示完全共识）减去个人得分的四分位距大小来衡量对每个政策选择的共识程度，对问卷结果进行了统计分析。来自不同背景的 17 名全球卫生专家参加了两轮研究，他们在该地区都至少有 20 年的经验。研究结果提供了一组专家意见的初步“映射”，并提出了一些有趣的经验教训。对于提出的 18 项政策选择，只有加强提供高质量初级卫生保健服务（判断为有效，信心得分 79 分，共识得分 90 分）和对最贫困人群免除费用（判断为实施相对容易，信心得分 66 分，共识得分 85 分）这两个选项达成了共识。对于 18 个常见政策选择，没有一个选项在潜在有效性和可行性方面达成共识，对于 5 个政策选项，意见存在很大分歧。专家组内部缺乏信心和共识似乎反映了对所提出的政策选择缺乏一致的证据。这表明，应在加强包容性和“循证审议进程”的框架内提出专家意见，在该进程中，可以在透明和上下文化的环境中讨论全民健康覆盖的三个维度（扩大覆盖人群以应对健康危害、扩大服务和福利覆盖范围以及降低自付支出）之间的权衡取舍。
