Distribution matters: Equity considerations among health planners in Tanzania
Distribution matters: Equity considerations among health planners in Tanzania
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DOI：
10.1016/j.healthpol.2007.07.012
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发表时间：
2008-02-01
期刊：
影响因子：
3.3
通讯作者：
Norheim, Ole Frithjof
中科院分区：
文献类型：
--
作者：
Ottersen, Trygve;Mbilinyi, Deogratius;Norheim, Ole Frithjof
背景：健康最大化作为卫生资源分配的指导原则受到对健康结果分布的关注的挑战。很少有实证研究在资源极度稀缺的情况下考虑这些潜在的不同目标。本研究的目的是通过探索坦桑尼亚卫生规划人员之间的分配偏好来帮助填补这一知识空白。方法：采用小组讨论法。参与者是通过战略抽样选出的地区和区域一级的卫生规划人员。健康计划人员在小组讨论和个人任务之间交替进行。答复者对不同目标群体的卫生规划进行了排名，并选择了他们认为在确定优先事项时应给予最重要重视的理由，并对其进行了排名。结果：大多数机构始终将较高的排名分配给目标群体初始预期寿命较低的项目。很高比例的答复者认为“影响预期寿命最短的人”是确定优先事项的最重要原因。结论：健康结果的分布，按生命年数计算，很重要。具体地说，目标群体的最初预期寿命越低，就越认为该方案很重要。在健康领域，这种偏好与伦理学家所说的“优先主义”是相容的。2007爱思唯尔爱尔兰有限公司版权所有。
Background: Maximising health as the guiding principle for resource allocation in health has been challenged by concerns about the distribution of health outcomes. There are few empirical studies that consider these potentially divergent objectives in settings of extreme resource scarcity. The aim of this study is to help fill this knowledge gap by exploring distributional preferences among health planners in Tanzania.Methods: A deliberative group method was employed. Participants were health planners at district and regional level, selected by strategic sampling. The health planners alternated between group discussion and individual tasks. Respondents ranked health programmes with different target groups, and selected and ranked the reasons they thought should be given most importance in priority setting.Results: A majority consistently assigned higher rankings to programmes where the initial life expectancy of the target group was lower. A high proportion of respondents considered "affect those with least life expectancy" to be the most important reason in priority setting.Conclusions: Distribution of health outcomes, in terms of life-years, matters. Specifically, the lower the initial life expectancy of the target group, the more important the programme is considered. Such preferences are compatible, within the sphere of health, with what ethicists call "prioritarianism". (c) 2007 Elsevier Ireland Ltd. All rights reserved.