School of Dental Sciences, Newcastle University, Newcastle Upon Tyne, UK.
Centre for the Business and Economics of Health, University of Queensland, Saint Lucia, Queensland, Australia.
J Dent Res. 2021 Jun;100(6):576-582. doi: 10.1177/0022034520986794. Epub 2021 Jan 21.
Despite the recognized need to change the emphasis of health services by shifting the balance from treatment to prevention, limited progress has been made in many settings. This is true in oral health, where evidence for preventive interventions that work has not been systematically exploited in oral health services. While reorienting health services is complex and context specific, economics can bring a helpful perspective in understanding and predicting the impact of changes in resource allocation, provider remuneration systems, and patient payments. There is an increasing literature on the economics of different prevention approaches. However, much of this literature focuses on the costs and potential savings of alternative approaches and fails to take into account benefits. Even where benefits are taken into account, these tend to be narrowly focused on clinical outcomes using cost-effectiveness analysis, which may be of little relevance to the policy maker, patient, and the public. Some commonly used economic approaches (such as quality-adjusted life years and incremental cost-effectiveness ratios) may also not be appropriate to oral health. Using alternative techniques, including wider measures of benefit and employing priority setting and resource allocation tools, may provide more comprehensive information on economic impact to decision makers and stakeholders. In addition, it is important to consider the effects of provider remuneration in reorienting services. While there is some evidence about traditional models of remuneration (fee for service and capitation), less is known about pay for performance and blended systems. This article outlines areas in which economics can offer an insight into reorientation of health systems toward prevention, highlighting areas for further research and consideration.
尽管人们已经认识到需要改变卫生服务的重点，将平衡从治疗转向预防，但在许多情况下，这方面的进展有限。在口腔健康领域也是如此，尽管有证据表明某些预防干预措施是有效的，但这些证据并未在口腔卫生服务中得到系统利用。虽然重新调整卫生服务是复杂且具体的，但经济学可以提供一个有用的视角，以理解和预测资源分配、提供者报酬制度和患者支付方式变化的影响。关于不同预防方法的经济学文献越来越多。然而，这些文献大多集中在替代方法的成本和潜在节省上，没有考虑到收益。即使考虑了收益，这些收益往往也仅限于使用成本效益分析的临床结果，这对决策者、患者和公众可能没有什么意义。一些常用的经济方法（如质量调整生命年和增量成本效益比）可能也不适合口腔健康。使用替代技术，包括更广泛的收益衡量标准，并采用优先级设置和资源分配工具，可以为决策者和利益相关者提供更全面的经济影响信息。此外，考虑提供者报酬在重新调整服务中的作用也很重要。虽然有一些关于传统报酬模式（按服务收费和人头费）的证据，但对于绩效报酬和混合系统的了解较少。本文概述了经济学可以为预防导向的卫生系统重新定位提供哪些见解，强调了进一步研究和考虑的领域。
