Institute of Health Economics, Edmonton, Alberta, Canada; Health Organisation, Policy, and Economics, School of Health Sciences, University of Manchester, United Kingdom.
Health Organisation, Policy, and Economics, School of Health Sciences, University of Manchester, United Kingdom.
Soc Sci Med. 2022 May;301:114900. doi: 10.1016/j.socscimed.2022.114900. Epub 2022 Mar 11.
The diagonal approach is a health system funding concept wherein vertical approaches targeting specific diseases are combined with horizontal approaches intended to strengthen health systems broadly. This taxonomy can also be used to classify health system interventions as either vertical or horizontal. Previous studies have used mathematical programming to evaluate horizontal interventions, but these models have not allowed concurrent evaluation of different types of horizontal interventions or captured spillovers and intertemporal effects. This paper aims to develop a theoretic framework for the diagonal approach. The framework is articulated through integer programming, maximizing health benefits given constraints by identifying the optimal set of both vertical and horizontal interventions to fund. The theoretic framework for the diagonal approach is developed by synthesizing and expanding three prior works. The decision problem is synthesised to allow concurrent evaluation of three different types of horizontal interventions, those: (i) improving health system efficiency, (ii) improving capacity, and (iii) investing in new platforms. Linear programs are converted to integer form, relaxing previous assumptions related to constant returns to scale and divisibility of interventions. The framework is expanded to evaluate multiple budget constraints and options for new platforms. A new form for the value function is used to estimate the benefits of intervention combinations, capturing spillovers between vertical and horizontal interventions and dynamic returns to scale. The decision problem is specified inferotemporally, explicitly capturing the impact of the time horizon on the optimal choice set. Dynamic examples are provided to demonstrate the advantages of the diagonal approach over prior frameworks. This framework extends existing works, enabling simultaneous comparison of various combinations of both vertical and horizontal interventions, capturing spillovers and intertemporal effects. The diagonal approach framework defines decision problems flexibly and realistically, forming the basis for future applied work. Implementation would improve resource allocation and patient health outcomes.
对角线方法是一种卫生系统筹资概念，其中针对特定疾病的垂直方法与旨在广泛加强卫生系统的水平方法相结合。这种分类法也可用于将卫生系统干预措施归类为垂直或水平。先前的研究使用数学规划来评估水平干预措施，但这些模型不允许同时评估不同类型的水平干预措施，也无法捕捉溢出效应和跨期效应。本文旨在为对角线方法制定一个理论框架。该框架通过整数规划来制定，通过确定垂直和水平干预措施的最佳组合来最大限度地提高健康效益，同时满足约束条件。通过综合和扩展三项先前的工作来制定对角线方法的理论框架。将决策问题综合起来，以允许同时评估三种不同类型的水平干预措施：(i)提高卫生系统效率，(ii)提高能力，以及(iii)投资新平台。将线性规划转换为整数形式，放宽了以前与规模报酬不变和干预措施可分性相关的假设。该框架扩展到评估多个预算限制和新平台的选择。使用新的价值函数形式来估计干预组合的效益，捕捉垂直和水平干预措施之间的溢出效应和动态规模报酬。将决策问题在 Inferotemporal 中指定，明确捕捉时间范围对最优选择集的影响。提供了动态示例，以展示对角线方法相对于先前框架的优势。该框架扩展了现有工作，能够同时比较各种垂直和水平干预措施的组合，捕捉溢出效应和跨期效应。对角线方法框架灵活而现实地定义决策问题，为未来的应用工作奠定了基础。实施将改善资源分配和患者健康结果。
