Health Economics Unit, University of Birmingham, Birmingham, UK.
Health Econ Policy Law. 2020 Jan;15(1):128-140. doi: 10.1017/S174413311800052X. Epub 2019 Jan 11.
Local authorities in England have responsibility for public health, however, in recent years, budgets have been drastically reduced placing decision makers under unprecedented financial pressure. Although health economics can offer support for decision making, there is limited evidence of it being used in practice. The aim of this study was to undertake in-depth qualitative research within one local authority to better understand the context for public health decision making; what, and how economics evidence is being used; and invite suggestions for how methods could be improved to better support local public health decision making. The study included both observational methods and in-depth interviews. Key meetings were observed and semi-structured interviews conducted with participants who had a decision-making role to explore views on economics, to understand the barriers to using evidence and to invite suggestions for improvements to methods. Despite all informants valuing the use of health economics, many barriers were cited: including a perception of a narrow focus on the health sector; lack of consideration of population impact; and problems with translating long timescales to short term impact. Methodological suggestions included the broadening of frameworks; increased use of natural experiments; and capturing wider non-health outcomes that resonate with the priorities of multiple stakeholders.
英格兰地方当局负责公共卫生，但近年来，预算大幅削减，决策者面临前所未有的财政压力。尽管健康经济学可以为决策提供支持，但实际上很少有证据表明它被使用。本研究旨在对一个地方当局进行深入的定性研究，以更好地了解公共卫生决策的背景；正在使用哪些经济学证据以及如何使用；并邀请有关如何改进方法以更好地支持地方公共卫生决策的建议。该研究包括观察法和深入访谈。对有决策作用的参与者进行了重点会议观察和半结构化访谈，以探讨对经济学的看法，了解使用证据的障碍，并邀请对方法改进的建议。尽管所有受访者都重视使用健康经济学，但也提出了许多障碍：包括对卫生部门狭隘关注的看法；缺乏对人口影响的考虑；以及将长时间尺度转化为短期影响的问题。方法学建议包括拓宽框架；更多地利用自然实验；以及捕捉更广泛的非健康结果，这些结果与多个利益相关者的优先事项产生共鸣。
