Murphy Peter, Griffin Susan, Fulbright Helen, Walker Simon
Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK.
Centre for Reviews and Dissemination, University of York, York, UK.
Pharmacoeconomics. 2025 May 23. doi: 10.1007/s40273-025-01507-x.
Task shifting between different cadres of health worker has been proposed as an approach to address workforce shortages. Whether such reallocation is a useful strategy for a health system depends on the potential costs and consequences. Too narrow a focus has implications for population health as resources could be incorrectly directed towards inefficient activities owing to important costs and/or benefits being omitted from the evaluation. We aim to identify the key issues when evaluating the value for money of task shifting and review the applied literature to determine whether it is fit for purpose.
We developed an a priori logic model of task shifting and searched five databases (MEDLINE, Embase, EconLit, Social Sciences Citation Index and CEA Registry) for economic evaluations of task shifting published between 2014 and 2024. We performed forwards and backwards citation searching. We considered the scope of the evaluations with respect to the ability to capture key costs and outcomes of task shifting from the logic model. Reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.
The rapid review identified 26 studies for inclusion covering 16 countries. Studies evaluated task shifting to community health workers and lay health workers as well as from doctors to radiographers, non-physician clinicians and nurse-midwives. The studies included health costs and outcomes but few included changes in the capacity of the workforce to undertake tasks, access, waiting times, productivity, burden on other staff, patient satisfaction, patient productivity and health equity concerns. There was a predominance for cost-effectiveness analysis to be used to assess the value for money of task shifting but the literature did include a cost-benefit analysis, a cost-consequence analysis and an extended cost-effectiveness analysis.
The majority of studies identified a range of costs and consequences that may only be appropriate for resource allocation under the strong assumption that all longer term costs and consequences would be unaffected by the task shift.
提议在不同类别的卫生工作者之间进行任务转移，作为解决劳动力短缺问题的一种方法。这种重新分配对卫生系统是否是一项有用的策略，取决于潜在的成本和后果。关注范围过窄会对人群健康产生影响，因为由于评估中遗漏了重要的成本和/或收益，资源可能会被错误地导向效率低下的活动。我们旨在确定评估任务转移性价比时的关键问题，并回顾应用文献，以确定其是否符合目的。
我们构建了一个任务转移的先验逻辑模型，并在五个数据库（医学期刊数据库、荷兰医学文摘数据库、经济文献数据库、社会科学引文索引数据库和成本效果分析注册库）中搜索2014年至2024年间发表的关于任务转移的经济评估。我们进行了向前和向后的引文检索。我们根据从逻辑模型中捕捉任务转移关键成本和结果的能力，考量评估的范围。使用《卫生经济评估报告标准合并清单》（CHEERS）评估报告质量。
快速综述确定了26项纳入研究，涵盖16个国家。研究评估了向社区卫生工作者和非专业卫生工作者的任务转移，以及从医生到放射技师、非医师临床医生和助产护士的任务转移。这些研究纳入了卫生成本和结果，但很少有研究纳入劳动力承担任务能力的变化、可及性、等待时间、生产力、对其他工作人员的负担、患者满意度、患者生产力以及卫生公平问题。在评估任务转移性价比时，主要使用成本效益分析，但文献中确实包括成本效益分析、成本后果分析和扩展成本效益分析。
大多数研究确定了一系列成本和后果，这些成本和后果可能仅在所有长期成本和后果不受任务转移影响的强假设下，才适合用于资源分配。
