Faculty of Medicine, University of Helsinki, Helsinki, Uusimaa, Finland
Nordic Healthcare Group Oy, Espoo, Finland.
BMJ Open. 2024 Nov 18;14(11):e086342. doi: 10.1136/bmjopen-2024-086342.
Study objective was to map the current literature on the economic effects of priority setting at the system level in healthcare.
The study was conducted as a scoping review.
Scopus electronic database was searched in June 2023.
We included peer-reviewed articles published 1 January 2020-1 January 2023. All study designs that contained empirical evidence on the financial effects or opportunity costs of healthcare priority setting were included excluding disease, condition, treatment, or patient group-specific studies.
Two independent researchers screened the articles, and two additional researchers reviewed the full texts and extracted data. We used Joanna Briggs Institute checklists to assess the quality of qualitative, quasi-experimental and economic evaluations and the mixed methods appraisal tool for the mixed method studies. Synthesis was done qualitatively and through descriptive statistics.
8869 articles were screened and 15 fulfilled the inclusion criteria. The most common study focus was health technology assessment (7/15). Other contexts were opportunity costs, effects of programme budgeting and marginal analysis, and disinvestment initiatives. Priority setting activities analysed in the studies did not achieve cost savings or cost containment (4/15) or have mixed findings at best (8/15). Only five studies found some indication of cost savings, cost containment or increased efficiency. Also, many of the studies consider costs only indirectly or qualitatively.
All in all, there is very little research addressing the pressing question of whether explicit priority setting and priority-setting methods can support cost containment on a health service system level (regional or national). There is limited evidence of the economic effects of priority setting.
本研究旨在绘制当前关于医疗保健系统层面优先排序的经济影响的文献图谱。
本研究采用范围综述方法进行。
2023 年 6 月在 Scopus 电子数据库中进行检索。
纳入 2020 年 1 月 1 日至 2023 年 1 月 1 日发表的同行评审文章。所有包含医疗保健优先排序财务影响或机会成本的实证证据的研究设计均被纳入，不包括疾病、状况、治疗或患者群体特定的研究。
两名独立研究人员筛选文章，另外两名研究人员审查全文并提取数据。我们使用 Joanna Briggs 研究所清单评估定性、准实验和经济评估的质量，以及混合方法研究的混合方法评估工具。综合分析采用定性和描述性统计方法。
筛选出 8869 篇文章，其中 15 篇符合纳入标准。最常见的研究重点是卫生技术评估（7/15）。其他研究背景包括机会成本、方案预算和边际分析的影响以及撤资计划。研究中分析的优先排序活动没有实现成本节约或成本控制（4/15），或最多只有混合结果（8/15）。只有 5 项研究发现了一些成本节约、成本控制或提高效率的迹象。此外，许多研究仅间接地或定性地考虑成本。
总体而言，几乎没有研究解决明确的优先排序和优先排序方法是否能够支持医疗服务系统层面（区域或国家）的成本控制这一紧迫问题。关于优先排序的经济影响的证据有限。
