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首页> 美国卫生研究院文献>Frontiers in Public Health >Making Hard Choices in Local Public Health Spending With a Cost-Benefit Analysis Approach
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Making Hard Choices in Local Public Health Spending With a Cost-Benefit Analysis Approach

机译：成本效益分析方法在地方公共卫生支出中做出艰难选择

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>Background: In 2013, public health moved into Local Authorities, but initial optimism has been overtaken by serious ongoing financial constraints and an uncertain future. Hard choices have become an everyday reality across local authorities and for their public health teams. Assessing the return-on-investment of public health interventions and possessing economic evaluation skills have become more critical than ever before.>Methods: Using the New Economy cost-benefits-analysis model developed at the Greater Manchester Combined Authority, we undertook cost benefit analyses of some of our largest areas of commissioned spend in local public health practice to better understand both the public and fiscal returns of our interventions.>Results: The cost-benefit analyses indicated considerable variation in the public (economic and social) returns-on-investment for our spend on services purchased as a commissioner with £1.37 to 6.81 returned for every £1 spent, and a fiscal return for every £1 invested of between £0.54 and 1.37. Additionally, the fiscal benefits (reduced service costs) of these public health interventions appear to primarily flow to the NHS, which accounts for about 94% of the fiscal return.>Conclusion: While cost-benefit modeling cannot provide a complete picture of “value,” it does provide decision-makers with a transparent metric that facilitates a whole-of system discussion on “intervention value” and prevention at scale investments. This approach will support investment strategies when implementing Sustainability and Transformation Partnerships and Integrated Care Systems. However, these tools should be used to support robust decision-making processes, not as a replacement for or a short-circuiting of existing processes.
机译：>背景： 2013年，公共卫生进入了地方当局，但最初的乐观情绪已被严重的持续财务限制和不确定的未来所取代。艰难的选择已成为地方当局及其公共卫生团队的日常工作。评估公共卫生干预措施的投资回报率和拥有经济评估技能比以往任何时候都变得更加重要。>方法：使用大曼彻斯特联合管理局开发的新经济成本效益分析模型，我们对当地公共卫生实践中某些最大的委托支出领域进行了成本收益分析，以更好地了解我们干预措施的公共和财政回报。>结果：成本效益分析表明差异很大在公共（经济和社会）投资回报中，我们以专员身份购买的服务的支出为每1英镑支出1.37英镑至6.81英镑，而每1英镑投资产生的财务回报为0.54英镑至1.37英镑。此外，这些公共卫生干预措施的财政收益（降低的服务成本）似乎主要流向了NHS，约占财政收益的94％。>结论：虽然成本效益模型无法提供完整地描述了“价值”，它确实为决策者提供了透明的指标，从而促进了有关“干预价值”和大规模投资预防的整个系统讨论。在实施可持续发展和转型伙伴关系以及综合护理系统时，该方法将支持投资策略。但是，这些工具应用于支持强大的决策流程，而不是替代或缩短现有流程。

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