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Integrating Social Justice Concerns into Economic Evaluation for Healthcare and Public Health: A Systematic Review

机译：将社会公正问题纳入医疗保健和公共卫生的经济评估：系统评价

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摘要

Social justice is the moral imperative to avoid and remediate unfair distributions of societal disadvantage. In priority setting in healthcare and public health, social justice reaches beyond fairness in the distribution of health outcomes and economic impacts to encompass fairness in the distribution of policy impacts upon other dimensions of well-being. There is an emerging awareness of the need for economic evaluation to integrate all such concerns. We performed a systematic review (1) to describe methodological solutions suitable for integrating social justice concerns into economic evaluation, and (2) to describe the challenges that those solutions face. To be included, publications must have captured fairness considerations that (a) involve cross-dimensional subjective personal life experience and (b) can be manifested at the level of subpopulations. We identified relevant publications using an electronic search in EMBASE, PubMed, EconLit, PsycInfo, Philosopher’s Index, and Scopus, including publications available in English in the past 20 years. Two reviewers independently appraised candidate publications, extracted data, and synthesized findings in narrative form. Out of 2388 publications reviewed, 26 were included. Solutions sought either to incorporate relevant fairness considerations directly into economic evaluation or to report them alongside cost-effectiveness measures. The majority of reviewed solutions, if adapted to integrate social justice concerns, would require their explicit quantification. Four broad challenges related to the implementation of these solutions were identified: clarifying the normative basis; measuring and determining the relative importance of criteria representing that basis; combining the criteria; and evaluating trade-offs. All included solutions must grapple with an inherent tension: they must either face the normative and operational challenges of quantifying social justice concerns or accede to offering incomplete policy guidance. Interdisciplinary research and broader collaborations are crucial to address these challenges and to support due attention to social justice in priority setting.
机译：社会正义是避免和纠正社会不利条件的不公平分配的道义要求。在卫生保健和公共卫生的优先领域中，社会公正不仅在分配健康成果和经济影响方面具有公平性，还可以涵盖在分配影响其他福祉方面的影响方面的公平性。人们日益认识到需要进行经济评估以综合所有这些问题。我们进行了系统的审查（1）描述了适合将社会正义问题纳入经济评估的方法论解决方案，并且（2）描述了这些解决方案所面临的挑战。要纳入出版物，出版物必须考虑到公平因素，其中（a）涉及跨维度的主观个人生活经验，并且（b）可以体现在亚人群的水平上。我们通过电子搜索在EMBASE，PubMed，EconLit，PsycInfo，哲学家索引和Scopus中找到了相关的出版物，包括过去20年中以英文提供的出版物。两位审稿人以叙事形式独立评估候选出版物，提取数据和综合发现。在审查的2388种出版物中，包括26种。解决方案寻求将相关的公平考虑因素直接纳入经济评估，或与成本效益措施一起报告。多数经过审查的解决方案如果要适应社会正义问题，都需要对其进行明确量化。确定了与实施这些解决方案有关的四个主要挑战：澄清规范基础；测量并确定代表该基础的标准的相对重要性；结合标准；和评估权衡。所有包括在内的解决方案都必须应对内在的紧张：它们要么必须面对量化社会正义问题的规范和运营挑战，要么必须提供不完整的政策指导。跨学科研究和更广泛的合作对于应对这些挑战并在优先重点确定中支持适当关注社会正义至关重要。

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