McCoy Matthew S, Dellgren Johan L, Emanuel Ezekiel J
Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Blockley Hall, 423 Guardian Drive, Philadelphia, PA19104, United States of America.
Bull World Health Organ. 2025 Jan 1;103(1):32-36. doi: 10.2471/BLT.24.291860.
The World Bank's report, represents an important effort to specify the benefits and criteria of fair processes in health financing decisions. Here we argue that the report's justification for increasing public engagement in health financing decisions, one of its most novel contributions, rests on a widely shared but flawed assumption that public engagement will produce more equitable outcomes. Examining evidence from national-level public engagement initiatives cited in the report, we argue that there is no reason to assume that engaged publics will prioritize equity over other relevant values such as the maximization of population health. We conclude that instead of seeing public engagement as a tool for advancing particular values, policy-makers should view it as a neutral way of assessing what the public values and gathering insights that can inform the design of health benefits packages. If policy-makers wish to prioritize equity, they should do so directly through substantive policy choices regarding the design and financing of coverage schemes.
世界银行的这份报告是明确卫生筹资决策中公平程序的益处和标准的一项重要努力。在此我们认为，该报告增加公众参与卫生筹资决策的理由（这是其最具创新性的贡献之一）基于一个广泛认同但有缺陷的假设，即公众参与将产生更公平的结果。通过审视该报告中引用的国家级公众参与倡议的证据，我们认为没有理由假定参与其中的公众会将公平置于其他相关价值观（如人口健康最大化）之上。我们的结论是，政策制定者不应将公众参与视为推进特定价值观的工具，而应将其视为一种评估公众价值观以及收集可为医保福利包设计提供参考的见解的中立方式。如果政策制定者希望优先考虑公平，他们应直接通过有关覆盖计划设计和筹资的实质性政策选择来做到这一点。
