Arcari Anna, Picozzi Mario, Pistoni Anna, Battisti Davide, Ceruti Silvia
Department of Economics, Insubria University, Varese, Italy.
Department of Biotechnology and Life Science, Insubria University, Varese, Italy.
J Eval Clin Pract. 2025 Mar;31(2):e14119. doi: 10.1111/jep.14119. Epub 2024 Sep 1.
The COVID-19 pandemic has not only tested the resilience of public health systems but also underscored the criticality of allocative choices on health resources. These choices, however, are not confined to health emergencies but are integral to public health decisions, which inherently grapple with limited resources. In this context, physicians play a pivotal role as the architects of clinical actions in various scenarios. Therefore, doctors are called upon to make their decisions by considering not only the criteria of clinical appropriateness but also the ethical aspects linked, in particular, to the principle of justice. Indeed, the assessment of the effectiveness of a treatment for a particular patient must be balanced against criteria of equity and justice for the whole. To be fully applied, the principle of justice presupposes the use of economic evaluation techniques designed to drive the organisation decisions by effectiveness and efficiency.
The present paper aims to empirically analyse whether and to what extent economic evaluation is known and used by doctors in healthcare decision-making and, therefore, what the most widespread approaches are used in such processes. In particular, this paper intends to present the results of an empirical study on a sample of doctors registered with the Order of Physicians in Lombardy (Italy), one of the areas most affected by the COVID-19 pandemic.
The research reveals a particular awareness of the criticality of allocation issues accompanied by a lack of knowledge of the economic evaluation techniques or, more broadly, by an almost total disuse of financial criteria. The main reasons are doctors' need for more knowledge of these tools and insufficient availability of economic information at the country system level.
In the conclusion, we propose some suggestions to facilitate the transition to more current decision-making models consistent with the characteristics of more advanced national healthcare contexts.
新冠疫情不仅考验了公共卫生系统的韧性，还凸显了卫生资源分配选择的重要性。然而，这些选择不仅限于卫生紧急情况，而是公共卫生决策不可或缺的一部分，而公共卫生决策本质上要应对资源有限的问题。在这种背景下，医生在各种情况下作为临床行动的设计者发挥着关键作用。因此，要求医生在做决策时不仅要考虑临床适宜性标准，还要考虑特别是与公正原则相关的伦理方面。事实上，对特定患者治疗效果的评估必须与整体的公平和公正标准相平衡。要全面应用公正原则，前提是使用旨在根据有效性和效率推动组织决策的经济评估技术。
本文旨在实证分析医生在医疗决策中是否知晓并使用经济评估以及使用的程度，因此，在此类过程中最广泛使用的方法是什么。特别是，本文打算展示对意大利伦巴第地区医师公会注册的医生样本进行实证研究的结果，伦巴第是受新冠疫情影响最严重的地区之一。
研究表明，医生对分配问题的重要性有一定认识，但对经济评估技术缺乏了解，或者更广泛地说，几乎完全不使用财务标准。主要原因是医生需要更多了解这些工具，以及国家系统层面经济信息的可获取性不足。
在结论部分，我们提出了一些建议，以促进向更符合更先进国家医疗环境特点的当前决策模式转变。
