卫生技术评估与医疗保险

医疗保险在许多国家被证明能够有效提升医疗服务质量。然而，如何控制医疗保险系统费用的增长仍是有待解决的问题。一些发达国家如英国，加拿大，瑞典将卫生技术评估结果与政府决策和医疗保险管理结合起来，使医疗费用得到控制同时卫生服务的质量得以提高。中国正在进行改革开展新的医疗保险计划。借鉴别国的经验对医疗保险体系的发展和管理意义重大。     

国际新兴卫生技术水平扫描系统建设经验及启示

随着卫生技术评估的发展,人们逐渐意识到评估时效对于卫生决策的重要性,于是出现了对新兴卫生技术早期和及时评估的需求。在卫生技术上市或开展实施前提供早期、及时评估,有助于留给决策者足够时间为一项新技术制定应用方法。新兴卫生技术评估可通过新兴卫生技术水平扫描系统开展,该系统能识别在卫生技术领域可能有重大影响的创新技术,从而促进适宜的新兴技术的临床运用。本文主要对加拿大、澳大利亚与新西兰、瑞典的3个新兴卫生技术水平扫描系统的情况进行概括及比较,从而为我国新兴卫生技术水平扫描系统的建设提供参考经验。     

中国适宜卫生技术评估研究的系统评价

目的全面总结和分析当今国内开展的适宜卫生技术评估的现状、评估内容及其问题。方法经检索人员讨论并预检索后确定检索词及检索策略,而后电子检索CBM、VIP、CNKI和万方数据库,查找1949年10月～2012年3月期间发表的所有描述中国适宜卫生技术评估的文献。由两名研究者按照纳入与排除标准独立进行文献筛选、资料提取并交叉核对,如有分歧讨论解决,必要时参考第三方意见。采用定性方法系统总结纳入文献的研究结果。结果最终共纳入174篇文献,其中横断面研究占117篇。研究人群主要包括已接受适宜卫生技术服务或治疗的患者和社区居民,以及使用或开展适宜卫生技术的基层医务人员和推广组织人员。目前适宜卫生技术主要包括中医(中医药)适宜卫生技术、西医适宜卫生技术、计划生育适宜卫生技术、以及社区卫生服务适宜卫生技术4个方面;涉及最多的疾病种类是循环系统疾病,其中最受关注的是高血压。适宜卫生技术评估内容主要包括6个方面:①有效性;②可接受性;③经济学特征;④需求性;⑤安全性;⑥技术特性。从纳入研究的结果看,目前国内针对适宜卫生技术的评估研究多从某一个方面进行评估,缺乏全面综合性评估,且每项评估内容所使用的指标涉及面太广泛,缺乏统一的评估指标标准。结论本系统评价结果显示,我国现有适宜卫生技术评估的领域分布较广;评估内容较单一,缺乏综合性;评估指标体系缺乏统一标准;评估研究设计方法不一,缺乏高质量的研究设计。提示需要进一步开展高质量的评估研究,建立科学的评估指标体系,对适宜卫生技术进行综合评价,从而为卫生决策者提供更科学的依据。     

卫生技术评估与循证医学

随着人口增长、年龄老化、新技术和新药物的应用、人类健康需求层次的提高,使全世界都面临着严峻的挑战：有限卫生资源与无限增长的卫生需求之间的矛盾。本文通过简要介绍卫生技术、卫生技术评估的基本概念,国际上卫生技术评估的产生背景、现况、评估的范畴和特点及评估结果对卫生技术合理应用的影响,国内卫生技术应用和评估的现状、存在问题,说明中我国建立具有权威性的卫生技术评估机构的必要性;同时阐述了循证医学与卫生技术     

卫生技术评估与医疗保险

医疗保险在许多国家被证明能够有效提升医疗服务质量。然而，如何控制医疗保险系统费用的增长仍是有待解决的问题。一些发达国家如英国、加拿大、瑞典将卫生技术评估结果与政府决策和医疗保险管理结合起来，使医疗费用得到控制同时卫生服务的质量得以提高。中国正在进行医疗改革开展新的医疗保险计划。借别国的经验对医疗保险体系的发展和管理意义重大。     

卫生专业技术人员实施量化考核需注意的几个问题

随着卫生事业改革的不断深入，优化卫生人力资源，提高医务人员素质已成为当前卫生改革的一项重要举措。对卫生技术人员进行全面量化考核，公正、合理地评价卫生技术人员的业务水平和技术能力，是卫生技术干部管理的一个关键环节。就乌鲁木齐地区而言，乌鲁木齐市中医医院等医疗机构做为乌鲁木齐市事业单位人事改革试点单位，从2000     

基于Delphi-聚类分析集成法的卫生技术需求与呼吸机装备的功能配置评估模式研究

目的构建基于卫生技术定位需求与装备技术配置功能的双向评估指标体系及测量方法,及生装备技术功能配置评估模式和操作机制。方法首先运用文献检索评价及Delphi法确定双向功能配置评估指标体系,然后利用组合赋权法计算需求功能与配置功能指标权重,最后利用系统聚类分析集成完成功能配置评估。结果两轮Delphi专家的积极性系数分别为75．56％和87．50％呼吸机双向功能配置评估指标体系结构。计算出综合ICU、急诊科和术后恢复病房3个科室需求功能权重和呼吸机配置功能权重,得到3个科室呼吸机配置功能的绝对重要度及排名：南聚类分析和呼吸机配置功能的绝对重要度排序,结合系统分析,得出适于不同样本领域装备呼吸机的功能配置方案。结论以卫生技术定位需求与装备技术配置两者最具代表性的标志指标功能为基础,建立双向功能配置评估指标体系并采用序贯集成方法测量,可作为卫生装备配置的评估模式,经实际功能技术利用效率调研校正,评估结果具有实效性。     

中国卫生技术评估与循证准入管理探索

目的探索从卫生部层面采用卫生技术评估的高质量证据,对影响广、费用高、风险大、有争议的卫生技术实行准入管理的可行性.方法借鉴国外卫生技术评估与循证管理实践的经验,在国内建立了四家卫生技术评估和循证医学相关机构,推动和开展卫生技术评估工作.以"脐带血造血干细胞库"、"人类辅助生殖技术"、"人类精子库"等技术的管理问题为切入点,领导开展技术评估,以高质量证据制定卫生部的准入管理办法和条例.结果开展多项有关医疗设备、临床医疗技术、预防与疾病控制的筛查技术等方面研究与评估;制定了多个单项技术评估与循证准入管理办法:<脐带血造血干细胞库管理办法>、<人类辅助生殖技术管理办法>、<人类精子库管理办法>等,指导各地机构和人员认证,规范管理.结论在我国建立卫生技术评估与循证准入管理制度已有一定基础,还需不断改进与完善,逐步形成行之有效的卫生技术准入管理运行机制.     

中国医院技术评估试点成效及推进策略

随着医院对卫生技术决策需求的不断增长,医院技术评估活动在世界范围内呈增长态势。多数发达国家,如法国、芬兰、丹麦、意大利、加拿大、美国和澳大利亚等都开展了医院技术评估活动。为进一步推动我国卫生技术评估事业的发展,树立医疗机构基于循证的管理与决策理念,国家卫生健康委医疗管理服务指导中心充分借鉴国外先进经验,开展了医院技术评估相关理论与实践研究。本文介绍我国医院技术评估试点的背景、对象、方法、内容、取得成效及对未来展望,为读者了解中国医院卫生技术评估整体情况及在医院开展卫生技术评估工作提供思路和参考。     

卫生技术评估:医疗器械科学监管的重要工具

卫生技术评估(HTA)是指对卫生技术性质及影响的系统评估,是采用卫生干预或卫生技术对社会、经济、组织和伦理所产生问题进行评价的方法体系.针对目前医疗器械领域可用性、可及性、可负担性、合理和安全性的问题,HTA能系统评估医疗器械的特性、效果和影响,为科学决策提供循证依据.本文从医疗器械的管理现状与挑战出发,介绍HTA的起...     

新医改背景下基于知证决策的医院卫生技术评估功能与机制

与传统卫生技术评估(HTA)相比,医院卫生技术评估(HB-HTA)从"组织视角"出发,需要立足医院实际情况、支持医院层面的管理决策。新医改对医院提出了更高的目标和要求,HB-HTA具有管理功能、经济功能和技术功能,可基于当前最优证据为卫生医疗政策管理和决策提供方法学支持,推动医院由行政决策向知证决策转变。作为HTA网络的组成部分,HB-HTA在卫生技术网络中通过纵向合作机制和横向扩散机制发挥作用,既同国家和地区HTA进行广泛的互动与合作,也可基于某一特定医学领域进行扩散。     

Health technology assessment in the ICU: noninvasive positive pressure ventilation for acute respiratory failure

Critical care practitioners have a number of health-related technologies at our disposal to provide the best possible care for our critically ill patients. Although certain technologies may improve outcomes in the intensive care unit (ICU), many technologies are disseminated without rigorous evaluation. Health technology assessment (HTA) in critical care is a complex and dynamic process, which is a powerful tool to assess a health technology for its initial use or continued application in the ICU. This article applies an HTA framework to the use of noninvasive positive pressure ventilation (NPPV) for patients with acute respiratory failure (ARF). The strongest evidence to date supports the use of NPPV in patients with ARF caused by exacerbations of chronic obstructive pulmonary disease (COPD); the benefit for patients with acute nonhypercarbic, hypoxemic respiratory failure is less clear. The success of NPPV technology depends on operator education and experience. The cost effectiveness of NPPV has been evaluated in patients with ARF caused by COPD, and cost reduction is attributed to the prevention of ventilator-associated pneumonia by avoiding endotracheal intubation. An HTA framework can help health care practitioners make important decisions regarding the acquisition of new technologies and the evaluation of current technologies. Careful evaluation of health technologies in the ICU should be an ongoing priority.     

Evaluating facts and facting evaluations: On the fact‐value relationship in HTA

Health technology assessment (HTA) is an evaluation of health technologies in terms of facts and evidence. However, the relationship between facts and values is still not clear in HTA. This is problematic in an era of “fake facts” and “truth production.” Accordingly, the objective of this study is to clarify the relationship between facts and values in HTA. We start with the perspectives of the traditional positivist account of “evaluating facts” and the social‐constructivist account of “facting values.” Our analysis reveals diverse relationships between facts and a spectrum of values, ranging from basic human values, to the values of health professionals, and values of and in HTA, as well as for decision making. We argue for sensitivity to the relationship between facts and values on all levels of HTA, for being open and transparent about the values guiding the production of facts, and for a primacy for the values close to the principal goals of health care, ie, relieving suffering. We maintain that philosophy (in particular ethics) may have an important role in addressing the relationship between facts and values in HTA. Philosophy may help us to avoid fallacies of inferring values from facts; to disentangle the normative assumptions in the production or presentation of facts and to tease out implicit value judgements in HTA; to analyse evaluative argumentation relating to facts about technologies; to address conceptual issues of normative importance; and to promote reflection on HTA's own value system. In this we argue for a(n Aristotelian) middle way between the traditional positivist account of “evaluating facts” and the social‐constructivist account of “facting values,” which we call “factuation.” We conclude that HTA is unique in bringing together facts and values and that being conscious and explicit about this “factuation” is key to making HTA valuable to both individual decision makers and society as a whole.     

Outcomes Measurement: Health-Related Quality of Life

Outcomes research is rapidly expanding and evolving in the assessment of medical treatment and has significant potential contributions to the assistive technology field. Over the past two decades, numerous instruments have been developed and are widely used to collect data for evaluating the efficacy and effectiveness of traditional medical interventions. Although this methodology may not transfer seamlessly to assistive technology, the basis of its instrumentation and many of its concepts are highly relevant. Many current and emerging medical and assistive technology interventions are vigorously advocated but have inadequately demonstrated their positive impact on outcome. A key concept used in medical technology outcomes measurement is health-related quality of life, which represents the functional effect of an illness and its consequent therapy as perceived by the individual receiving treatment. People tend to make decisions about alternative health care services by estimating the effects of an intervention on outcomes important to themselves, by comparing intervention benefits and harms and by deciding whether the outcomes are worth the costs. Numerous valid, reliable, and responsive health-related quality of life instruments are available and are designed to discriminate between individuals, to evaluate change over time, or to predict outcome. Many are worth examining for potential use or adaptation in assistive technology outcomes measurement. Some of these instruments are generic, some specific, and others deal with health state preference. Generic health-related quality of life instruments are broadly applicable across various diseases, conditions, or populations. Specific instruments focus on a given disease, condition, or population. Health state preference instruments assess an individual's desirability for a given health state or outcome. Assistive technology practitioners claim that they improve the quality of life for the individuals they serve. Health-related quality of life must then be considered an integral component of the evaluation of service effectiveness. This paper reviews the concepts and instrumentation used in medical technology assessment for consideration and potential application in assistive technology measurement.     

Market uptake of orphan drugs – a European analysis

What is known and Objective: Variations in market uptake of an orphan drug have important implications with respect to access to care and inequality of treatment. Therefore, the aim of this study was to quantify both the sales and volume uptake of orphan drugs in Europe and to assess whether a country’s gross domestic product (GDP) and/or health technology assessment (HTA) influences the orphan drugs’ market uptake. Methods: We analysed the numbers of orphan drugs launched and the sales and volume uptake for 17 orphan drugs in 23 European countries from 2001 until the beginning of 2010 using the IMS Health database. Countries were clustered based on GDP and the availability of a formal HTA‐organization. Results and Discussion: The uptake of orphan drugs varied across European countries. The highest volumes and contributions of orphan drugs in the first year occurred in countries with a high GDP (and implicitly, a higher budget for healthcare), independently of the existence of an HTA‐organization. In contrast, in countries with a low GDP, orphan drugs were less available when there was a formal HTA‐organization. There, budgetary restrictions can cause the exclusion of less cost‐effective orphan drugs. What is new and Conclusion: We observed substantial variation in the market uptake of orphan drugs. Such variation may have important implications with respect to access to care and inequality of treatment. The uptake of orphan drugs could be promoted through the clinical added value of orphan drugs (CAVOD) project and various conditional pricing and reimbursement mechanisms.     

卫生技术评估与医疗保险

医疗保险在许多国家被证明能够有效提升医疗服务质量。然而,如何控制医疗保险系统费用的增长仍是有待解决的问题。一些发达国家如英国、加拿大、瑞典将卫生技术评估结果与政府决策和医疗保险管理结合起来,使医疗费用得到控制同时卫生服务的质量得以提高。中国正在进行医疗改革开展新的医疗保险计划。借鉴别国的经验对医疗保险体系的发展和管理意义重大。