Priority setting of health interventions: the need for multi-criteria decision analysis.
Priority setting of health interventions: the need for multi-criteria decision analysis.
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DOI：
10.1186/1478-7547-4-14
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发表时间：
2006-08-21
期刊：
影响因子：
--
通讯作者：
Niessen L
中科院分区：
文献类型：
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作者：
Baltussen R;Niessen L
卫生干预措施的优先级设置通常是临时性的，并且资源没有得到最佳利用。根本问题是多种标准在发挥作用，决策也很复杂。可以选择干预措施来最大限度地提高总体人口健康，减少弱势群体或弱势群体的健康不平等，和/或应对危及生命的情况，所有这些都考虑到实际和预算限制。政策制定者通常不擅长理性、独立地解决这类问题。他们倾向于使用启发式或直观的方法来简化复杂性，而在此过程中，重要的信息被忽略。接下来，政策制定者可能仅出于政治动机而选择干预措施。这表明需要采取合理和透明的方法来确定优先事项。在过去的几十年里，已经开发了许多方法，包括循证医学、疾病负担分析、成本效益分析和公平分析。然而，这些方法仅集中于单一标准，而实际上，政策制定者需要同时考虑多个标准来做出选择。此外，它们并未涵盖与政策制定者相关的所有标准。因此，有必要制定多标准方法来确定优先事项，这实际上最近已被确定为卫生系统研究中最重要的问题之一。在其他科学学科中，多标准决策分析已得到很好的发展，已获得广泛接受并得到常规使用。本文介绍了多标准决策分析的主要原理。只有很少的应用程序可以指导健康方面的资源分配决策。我们呼吁从目前倾向于关注单一标准的卫生优先事项设定工具转向透明和系统的方法，同时考虑到所有相关标准。
Priority setting of health interventions is often ad-hoc and resources are not used to an optimal extent. Underlying problem is that multiple criteria play a role and decisions are complex. Interventions may be chosen to maximize general population health, to reduce health inequalities of disadvantaged or vulnerable groups, ad/or to respond to life-threatening situations, all with respect to practical and budgetary constraints. This is the type of problem that policy makers are typically bad at solving rationally, unaided. They tend to use heuristic or intuitive approaches to simplify complexity, and in the process, important information is ignored. Next, policy makers may select interventions for only political motives. This indicates the need for rational and transparent approaches to priority setting. Over the past decades, a number of approaches have been developed, including evidence-based medicine, burden of disease analyses, cost-effectiveness analyses, and equity analyses. However, these approaches concentrate on single criteria only, whereas in reality, policy makers need to make choices taking into account multiple criteria simultaneously. Moreover, they do not cover all criteria that are relevant to policy makers. Therefore, the development of a multi-criteria approach to priority setting is necessary, and this has indeed recently been identified as one of the most important issues in health system research. In other scientific disciplines, multi-criteria decision analysis is well developed, has gained widespread acceptance and is routinely used. This paper presents the main principles of multi-criteria decision analysis. There are only a very few applications to guide resource allocation decisions in health. We call for a shift away from present priority setting tools in health – that tend to focus on single criteria – towards transparent and systematic approaches that take into account all relevant criteria simultaneously.