Seixas Brayan V, Dionne François, Mitton Craig
Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, USA.
Prioritize Consulting Inc., Vancouver, Canada.
Health Econ Rev. 2021 Jan 7;11(1):2. doi: 10.1186/s13561-020-00300-0.
Due to growing expenditures, health systems have been pushed to improve decision-making practices on resource allocation. This study aimed to identify which practices of priority setting and resource allocation (PSRA) have been used in healthcare systems of high-income countries.
A scoping literature review (2007-2019) was conducted to map empirical PSRA activities. A two-stage screening process was utilized to identify existing approaches and cluster similar frameworks. That was complemented with a gray literature and horizontal scanning. A narrative synthesis was carried out to make sense of the existing literature and current state of PSRA practices in healthcare.
One thousand five hundred eighty five references were found in the peer-reviewed literature and 25 papers were selected for full-review. We identified three major types of decision-making framework in PSRA: 1) Program Budgeting and Marginal Analysis (PBMA); 2) Health Technology Assessment (HTA); and 3) Multiple-criteria value assessment. Our narrative synthesis indicates these formal frameworks of priority setting and resource allocation have been mostly implemented in episodic exercises with poor follow-up and evaluation. There seems to be growing interest for explicit robust rationales and ample stakeholder involvement, but that has not been the norm in the process of allocating resources within healthcare systems of high-income countries.
No single dominate framework for PSRA appeared as the preferred approach across jurisdictions, but common elements exist both in terms of process and structure. Decision-makers worldwide can draw on our work in designing and implementing PSRA processes in their contexts.
由于支出不断增加，卫生系统被迫改进资源分配的决策做法。本研究旨在确定高收入国家卫生保健系统中使用了哪些优先事项设定和资源分配（PSRA）做法。
进行了一项范围界定文献综述（2007 - 2019年），以梳理实证性的PSRA活动。采用两阶段筛选过程来确定现有方法并对类似框架进行聚类。同时辅以灰色文献和横向扫描。进行了叙述性综合分析，以理解现有文献以及卫生保健领域PSRA做法的当前状况。
在同行评审文献中找到1585篇参考文献，选择了25篇论文进行全面评审。我们在PSRA中确定了三种主要的决策框架类型：1）规划预算与边际分析（PBMA）；2）卫生技术评估（HTA）；3）多标准价值评估。我们的叙述性综合分析表明，这些优先事项设定和资源分配的正式框架大多在偶发性活动中实施，后续跟进和评估较差。对于明确有力的基本原理和广泛的利益相关者参与，兴趣似乎在增加，但这在高收入国家卫生保健系统的资源分配过程中并非常态。
在不同司法管辖区，没有单一占主导地位的PSRA框架成为首选方法，但在过程和结构方面存在共同要素。全球决策者可以借鉴我们的工作，在其背景下设计和实施PSRA流程。
