Department of Management Science, Strathclyde Business School, University of Strathclyde, Glasgow, UK.
Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand.
Health Care Manag Sci. 2022 Sep;25(3):460-483. doi: 10.1007/s10729-022-09594-4. Epub 2022 May 28.
Many countries seek to secure efficiency in health spending through establishing explicit priority setting institutions (PSIs). Since such institutions divert resources from frontline services which benefit patients directly, it is legitimate and reasonable to ask whether they are worth the money. We address this question by comparing, through simulation, the health benefits and costs from implementing two alternative funding approaches - one scenario in which an active PSI enables cost-effectiveness-threshold based funding decisions, and a counterfactual scenario where there is no PSI. We present indicative results for one dataset from the United Kingdom (published in 2015) and one from Malawi (published in 2018), which show that the threshold rule reliably resulted in decreased health system costs, improved health benefits, or both. Our model is implemented in Microsoft Excel and designed to be user-friendly, and both the model and a user guide are made publicly available, in order to enable others to parameterise the model based on the local setting. Although inevitably stylised, we believe that our modelling and results offer a valid perspective on the added value of explicit PSIs.
许多国家试图通过建立明确的优先设置机构（PSIs）来确保卫生支出的效率。由于这些机构将资源从直接使患者受益的一线服务中转移出来，因此，询问它们是否物有所值是合理和正当的。我们通过模拟比较了两种替代供资方法的健康效益和成本——一种情况是，一个积极的 PSI 能够根据成本效益阈值做出供资决策，另一种情况是没有 PSI。我们展示了来自英国（2015 年发布）和马拉维（2018 年发布）的一个数据集的指示性结果，结果表明，阈值规则可靠地降低了卫生系统成本，提高了健康效益，或两者兼而有之。我们的模型是在 Microsoft Excel 中实现的，设计为用户友好型，并且模型和用户指南都公开提供，以便其他人能够根据当地情况对模型进行参数化。尽管不可避免地带有风格化，但我们相信，我们的建模和结果为明确的 PSIs 的附加值提供了一个有效的视角。
