Murray C J, Kreuser J, Whang W
Harvard Center for Population and Development Studies, Cambridge, MA 02138.
Bull World Health Organ. 1994;72(4):663-74.
The role of health systems infrastructure in studies of cost-effectiveness analysis and health resource allocation is discussed, and previous health sector cost-effectiveness analyses are cited. Two substantial difficulties concerning the nature of health system costs and the policy choices are presented. First, the issue of health system infrastructure can be addressed by use of computer models such as the Health Resource Allocation Model (HRAM) developed at Harvard, which integrates cost-effectiveness and burden of disease data. It was found that a model which allows for expansion in health infrastructure yields nearly 40% more total DALYs for a hypothetical sub-Saharan African country than a model which neglects infrastructure expansion. Widespread use of cost-effectiveness databases for resource allocations in the health sector will require the cost-effectiveness analyses shift from reporting costs to reporting production functions. Second, three distinct policy questions can be treated using these tools, each necessitating its own inputs and constraints: allocations when given a fixed budget and health infrastructure, or when given resources for marginal expansion, or when given a politically constrained situation of expanding resources. Confusion concerning which question is being addressed must be avoided through development of a consistent and rigorous approach to using cost-effectiveness data for informing resource allocations.
讨论了卫生系统基础设施在成本效益分析和卫生资源分配研究中的作用，并引用了以往卫生部门的成本效益分析。提出了关于卫生系统成本性质和政策选择的两个重大难题。首先，卫生系统基础设施问题可以通过使用计算机模型来解决，如哈佛大学开发的卫生资源分配模型（HRAM），该模型整合了成本效益和疾病负担数据。研究发现，对于一个假设的撒哈拉以南非洲国家，一个考虑卫生基础设施扩张的模型比一个忽视基础设施扩张的模型产生的总伤残调整生命年（DALYs）多近40%。在卫生部门广泛使用成本效益数据库进行资源分配，将要求成本效益分析从报告成本转向报告生产函数。其次，可以使用这些工具处理三个不同的政策问题，每个问题都需要其自身的投入和约束条件：在给定固定预算和卫生基础设施的情况下进行分配，或在给定边际扩张资源的情况下进行分配，或在资源扩张受到政治限制的情况下进行分配。必须通过制定一种一致且严谨的方法来使用成本效益数据为资源分配提供信息，以避免对正在解决的问题产生混淆。
