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首页> 外文期刊>Journal of Health Services Research & Policy >Health care resource allocation: is the threshold rule good enough?
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Health care resource allocation: is the threshold rule good enough?

机译：卫生保健资源分配：阈值规则是否足够好？

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摘要

We review the foundations of resource allocation rules based on cost-effectiveness information. Comprehensivenapproaches, where a total budget is allocated in one go, require estimation of the costs and effects of all availablenhealth care programmes, which is unlikely to be practical. A common alternative is to assess individual programmesnagainst a cost-effectiveness threshold. This has been shown to be efficient if the threshold is well calibrated and allnprogrammes can be wholly or partially implemented with constant returns to scale. We discuss the feasibility of thesenassumptions, and the effects of relaxing them, concluding that programme indivisibility is unlikely to be a seriousnproblem at a national level, but that miscalibration of the threshold and non-constant returns to scale might be. Anrule that avoids these difficulties has been proposed previously: a new programme should only be implemented if itncan be funded by cancelling another less effective programme. This could never reduce efficiency, unlike thenthreshold rule, though we show that it might sometimes fail to recommend an efficiency-improving change. Wensuggest a refinement of this reallocation rule based on explicit estimation of the costs and effects of partialnimplementation of the programmes under review. Research is required to assess the practicality of this option.
机译：我们回顾基于成本效益信息的资源分配规则的基础。一目了然地分配总预算的综合方法要求估算所有可用的卫生保健计划的成本和效果，这不太可能实用。一种常见的替代方法是根据成本效益阈值来评估各个计划。如果阈值得到了很好的校准，并且可以以恒定的规模回报完全或部分实施allnprograms，那么这将被证明是有效的。我们讨论了这些举动的可行性，以及放宽举动的影响，得出结论认为，在国家一级，计划的不可分割性不太可能是一个严重的问题，但门槛的校准不当以及规模收益会不断变化。以前曾提出过避免这些困难的规则：只有通过取消另一个效果较差的计划才能为其提供资金的情况下，才可以实施新计划。与阈值规则不同，这永远不会降低效率，尽管我们证明有时可能无法建议提高效率的变化。 Wensuggest根据对所审查计划的部分实施的成本和效果的显式估计，对该重新分配规则进行了完善。需要进行研究以评估此选项的实用性。

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