Morrow R H, Bryant J H
Department of International Health, School of Hygiene and Public Health, USA.
Am J Public Health. 1995 Oct;85(10):1356-60. doi: 10.2105/ajph.85.10.1356.
To achieve more cost-effective and equitable use of health resources, improved methods for defining disease burdens and for guiding resource allocations are needed by health care decision makers. Three approaches are discussed that use indicators that combine losses due to disability with losses due to premature mortality as a measure of disease burden. These indicators can also serve as outcome measures for health status in economic analyses. However, their use as tools for measuring and valuing human life raises important questions concerning the measurement of mortality and the multidimensions of morbidity; valuing of life, particularly regarding weighting productivity, dependency, age, and time-preference factors; and conflicts between equity and efficiency that arise in allocation decisions. Further refinement of these tools is needed to (1) incorporate national and local values into weighting; (2) elaborate methods for disaggregating calculations to assess local disease patterns and intervention packages; and (3) develop guidelines for estimating marginal effects and costs of interventions. Of utmost importance are methods that ensure equity while achieving reasonable efficiency.
为了更具成本效益且公平地利用卫生资源，医疗保健决策者需要改进界定疾病负担和指导资源分配的方法。本文讨论了三种方法，这些方法使用将残疾导致的损失与过早死亡导致的损失相结合的指标作为疾病负担的衡量标准。这些指标还可作为经济分析中健康状况的结果指标。然而，将它们用作衡量和评估人类生命的工具引发了一些重要问题，涉及死亡率的衡量以及发病率的多维度；生命的估值，特别是在权衡生产力、依赖性、年龄和时间偏好因素方面；以及分配决策中出现的公平与效率之间的冲突。需要进一步完善这些工具，以便：（1）将国家和地方价值观纳入权重计算；（2）详细阐述分解计算的方法，以评估地方疾病模式和干预方案；（3）制定估计干预措施边际效应和成本的指南。至关重要的是确保公平同时实现合理效率的方法。
