药物经济学评价在国际卫生决策领域的应用现状、问题与对策

药物经济学相对来说是一门新兴的边缘学科,它是许多学科包括卫生经济学、决策分析和循证医学等的交叉学科。通过应用最小成本法、成本效用分析、成本效果分析和成本效益分析等分析技术,药物经济学评价已经渗透到了卫生决策分析过程中,成为除传统的有效性和安全性之外的又一种方法。     

卫生服务的效率及其测量

效率是卫生服务部分经济学评价的重要原则之一,包括3层含义：技术效率、成本－效果和配置效率,文章阐述了对有关概念的不同理解及各种测量方法。常用以下方法测量技术效率：比率分析法、秩和比法、综合指数法和数据包络分析（DEA）等;用生产函数来测量经济效率;用成本效果分析（CEA）、成本效用分析（CUA）和成本效果分析（CBA）评价成本结果。评价配置效率的指标主要有：医疗和预防服务的比例、基本医疗和非基本医疗服务的比例、卫生总费用的流向等。     

浅析卫生经济学评价方法

本文从卫生经济学评价概念出发,重点阐述了卫生经济学评价常用的4种评价方法的概念、应用范围、指标的测量技术、优缺点以及评价方法之间的比较,为正确评价各种卫生经济活动提供有力的技术帮助。     

广西示范县大规模HIV筛查项目工作卫生经济学分析

目的 对广西3个示范县2013-2015年开展的大规模HIV筛查项目进行卫生经济学评价。方法 通过卫生经济学评价和Markov模型相结合的方法,分析比较3个示范县项目实施的短期及长期卫生经济学价值。结果 该项目整体HIV阳性发现成本为1.597万元/例,每挽回1个DALY的成本为256.912元,项目直接成本效益比为1∶39.662。Markov模型结果显示,项目累计可挽回12 736.11个QALY,其成本效用比为0.206万元/QALY。A县各项卫生经济学指标均优于B、C县。结论 该项目具有一定卫生经济学价值,即使在艾滋病流行相对较低的地区大规模筛查仍符合成本效果原则的。     

卫生经济学评价方法在医用耗材精益招用中的应用研究

医用耗材招用存在着依据难以客观化和评价不全面等问题。通过对医用耗材精益招用实质分析,引入CEA（成本—效果分析法）、CMA（最小成本分析）、CUA（成本—效用法）、CBA（成本—效益法）等卫生经济学评价方法,将医用耗材性价比由主观、定性判定转向客观、定量判定,达到降低医疗成本,提高医疗效益的目的。通过案例分析,说明卫生经济学评价方法,尤其是成本-效果法在医用耗材精益招用中的应用成效。     

糖网病卫生经济学评价动态研究

该文系统阐述了国内外已有的糖网病卫生经济评价研究动态,相比国外在研究对象、方法及模式上的成熟研究,我国的糖网病经济学评价尚处于初始阶段,建议拓宽我国糖网病研究范围,完善成本分析技术手段,统一卫生经济分析指标等,为DR相关卫生经济学评价提供理论和方法学依据,并为政府和卫生部门的政策制定提供支持.     

医院经济管理指标评价系统的开发与应用

运用卫生经济学成本效益、成本效果、成本效用的理论，研究我军医院经济管理评价体系及运行模式。结合医院不同卫生经济信息点，筛选确立了22项卫生经济评价指标，建立了一套适合不同层次卫生行政人员的指标评价系统，为科室评价医院经济管理水平和经济发展状况提供了一种有效方法。     

卫生经济学评价方法在临床路径中的适用性、现状及应用思路

了解卫生经济学评价方法及其在临床路径中的适用性,正确认识和应用卫生经济学评价方法,对科学建立和客观评价临床路径具有重要意义。文章通过对卫生经济学评价的概念、4种方法的特征和适用性以及应用现状的比较分析,提出了临床路径卫生经济学评价的应用思路。     

我国上消化道癌筛查卫生经济学研究的系统评价

目的 系统评价我国人群上消化道癌筛查项目的卫生经济学研究现状。方法 在中国知网、万方、维普网、The Cochrane Library、PubMed和EMbase中检索关于我国人群上消化道癌筛查卫生经济学评价的研究,提取纳入研究的数据资料,评价研究质量,并对筛查效果、卫生经济学结果进行分析。结果 共纳入8个相关研究。研究整体质量尚可。筛查项目的卫生经济学评价结果用成本-效果比与GDP的比值来测量。结果表明,内窥镜方法筛查项目为0.02～0.15;血ELISA抗体方法的结果为0.01～0.21;血清胃蛋白酶原方法为0.04;高危人群与普通人群筛查的成本-效果比与GDP的比值结果相似,但普通人群的筛查成本较高;不同癌症类型间筛查的卫生经济学结果显示,胃癌筛查效果较好。结论 我国高危地区采用内窥镜方法进行上消化道癌筛查的卫生经济学效果良好,尤其针对胃癌的筛查经济效果较好。     

青少年和成人百日咳疫苗加强免疫策略卫生经济学研究的系统评价北大核心

目的系统评价青少年和成人百日咳疫苗加强免疫的卫生经济学研究质量和结果。方法通过Pubmed、中国知网等数据库检索2000年1月-2020年1月发表的青少年和成人百日咳疫苗加强免疫卫生经济学研究文献,采用卫生经济研究统一整理评估报告标准(Consolidated health economic evaluation reporting standards,CHEERS)评分(满分24分)评价文献质量,分析卫生经济学评价结果。结果共纳入符合标准的研究文献16篇,均为国外文献,文献的CHEERS评分平均为22.56分(范围:20-24分)。针对青少年或成人百日咳加强免疫策略,8篇研究认为符合成本效果或节约成本(7篇研究人群为青少年),5篇研究认为在一定条件下(如百日咳发病率>50/10万)符合成本效果,3篇研究认为不符合成本效果。结论纳入的研究文献质量较高;经济学评价结果倾向于支持青少年百日咳加强免疫策略,而成人加强免疫策略评价结果差异较大。建议开展中国百日咳免疫策略的卫生经济学研究。     

Stated preference methods in health care evaluation: an emerging methodological paradigm in health economics

One focus of health economics is the trade-off between limited resources and the (health) needs of a community. Cost-effectiveness analysis (CEA), while being one of the most accepted evaluation methodologies in health economics, does not account for many important costs and benefits of health care interventions. Some health economists have attempted to modify CEA to account for these deficiencies, while others have been working on alternative methodologies. One group of alternative methodologies can be described as stated preference techniques. These aim to measure both health and non-health outcomes (ie costs and benefits), and include qualitative analysis, conjoint analysis (often referred to as discrete choice analysis/modelling) and willingness to pay (or contingent valuation). This paper provides an overview of stated preference techniques in health economics, with particular focus on their strengths as compared with traditional evaluation methods in health care. The limitations and policy implications of these methods are also discussed.     

Paradigms and research programmes: is it time to move from health care economics to health economics?

As an applied subdiscipline of economics, health economics has flourished, defining itself as the study of how scarce health care resources may be used to meet our needs. This evolutionary pathway has led to health economists adopting a very 'medical' model of health, in which the predominant production function for health is health care. This paper sets out policy challenges to health economics which have arisen in light of growing recognition by governments of the socioeconomic determinants of health and their stated commitment to tackle inequalities in health. It reviews Thomas Kuhn's theory of paradigm shift and Imre Lakatos' theory of scientific research programmes in the natural sciences, favouring the latter as an explanation of the evolution of the subdiscipline of health economics. The paper brings together four recently published visions of the future of health economics-visions that are almost exclusively focused on the production, organization and distribution of health care. In contrast to these visions, in Lakatosian terms, this paper challenges the subdiscipline's core 'positive heuristic', i.e. the set of imperatives which determines how the research programme should unfold, how it may be defended, its scope and boundaries. This paper argues that health economics will need to evolve to embrace a more socioeconomic model of health and, to this end, offers for debate an expansion of Williams' diagrammatic representation of the subdiscipline. It concludes by asking whether the magnitude and the magnetism of health care policy issues will continue to prove too strong to allow health economists, should they wish, to steer their research and educational programmes more directly towards 'health' rather than 'health care' as the relevant social want.     

新医改的新政治经济学分析

运用新政治经济学谱系中的制度变迁理论、公共选择理论和委托代理理论,对新医改中的有关问题进行初步分析,探讨新医改中正确处理政府、市场与医疗部门之间关系的思路与方法,阐述了新政治经济学在医改中的应用与发展。     

Choice and accountability in health promotion: the role of health economics

Choices need to be made between competing uses of health careresources. There is debate about how these choices should bemade, who should make them and the criteria upon which theyshould be made. Evaluation of health care is an important partof this debate. It has been suggested that the contributionof health economics to the evaluation of health promotion islimited, both because the methods and principles underlyingeconomic evaluation are unsuited to health promotion, and becausethe political and cultural processes governing the health caresystem are more appropriate mechanisms for allocating healthcare resources than systematic economic analysis of the costsand benefits of different health care choices. This view misrepresentsand misunderstands the contribution of health economics to theevaluation of health promotion. It overstates the undoubtedmethodological difficulties of evaluating health promotion.It also argues, mistakenly, that economists see economic evaluationas a substitute for the political and cultural processes governinghealth care, rather than an input to them. This paper arguesfor an economics input on grounds of efficiency, accountabilityand ethics, and challenges the critics of the economic approachto judge alternative mechanisms for allocating resources bythe same criteria.     

Designs and methods used in published Australian health promotion evaluations 1992–2011

Objective: To describe the designs and methods used in published Australian health promotion evaluation articles between 1992 and 2011. Methods: Using a content analysis approach, we reviewed 157 articles to analyse patterns and trends in designs and methods in Australian health promotion evaluation articles. The purpose was to provide empirical evidence about the types of designs and methods used. Results: The most common type of evaluation conducted was impact evaluation. Quantitative designs were used exclusively in more than half of the articles analysed. Almost half the evaluations utilised only one data collection method. Surveys were the most common data collection method used. Few articles referred explicitly to an intended evaluation outcome or benefit and references to published evaluation models or frameworks were rare. Conclusion: This is the first time Australian‐published health promotion evaluation articles have been empirically investigated in relation to designs and methods. There appears to be little change in the purposes, overall designs and methods of published evaluations since 1992. Implications: More methodologically transparent and sophisticated published evaluation articles might be instructional, and even motivational, for improving evaluation practice and result in better public health interventions and outcomes.     

农村卫生适宜技术应用中的福利经济学分析

运用福利经济学的基本原理和基本方法,分析了农村卫生适宜技术推广应用的必要性及其对农村卫生福利效率和效用的影响,并用福利经济学的理念提出了农村卫生适宜技术筛选模型和多渠道补偿机制。     

医疗体制改革的理论思考

近来有关中国医疗体制改革的讨论，逐渐涉及公共经济学、卫生经济学理论层面的一些基本理念和基础概念，解决中国医疗体制改革缺陷的不少主张，也因为对基本理论、概念的混淆和对医改问题的历史成因认识不清，而对医疗服务中政府与市场作用的边界，以及在公平与效率的关系上陷入形而上学的思维方式。因此，有必要从理论和历史的视角上正确理解医疗服务性质、合理定位医疗体制改革，避免出现将政府作用神化和市场作用神化两个极端，重新厘定政府与市场、公平与效率在医疗体制改革进程中的均衡。     

Understanding population health terminology

Population health is a relatively new term, with no agreement about whether it refers to a concept of health or a field of study of health determinants. There is debate, sometimes heated, about whether population health and public health are identical or different. Discussions of population health involve many terms, such as outcomes, disparities, determinants, and risk factors, which may be used imprecisely, particularly across different disciplines, such as medicine, epidemiology, economics, and sociology. Nonetheless, thinking and communicating clearly about population health concepts are essential for public and private policymakers to improve the population's health and reduce disparities. This article defines and discusses many of the terms and concepts characterizing this emerging field.     

经济学视野下的健康与卫生政策研究

在整体方面,经济学认为健康是劳动力与资本,是社会经济体系中最主要的生产要素;在个体方面,经济学认为健康是人力资本,是能提高消费者满足程度的耐久资本品;经济学在稀缺性、替代性和异质性等3个基本概念上对卫生政策与卫生资源的合理配置产生了深刻的影响;经济学评价与实证研究以及规范性研究等不同的经济学研究方法也为卫生政策的研究提供了科学的决策依据。     

This is US: Geography of evidence in top health economics journals

The Journal of Health Economics and Health Economics are arguably the top two journals in the field of health economics. Together, they published 1,679 empirical research articles in the past decade (2010–2019). In line with analyses based on earlier periods, the empirical evidence in top health economics journals continues to be dominated by the United States (37% of all empirical articles), whereas studies based on low‐income countries remain rare (2%). Countries with higher disease burdens receive generally less attention from health economists publishing at the top of their field. Reflecting this, more research was published based on data from the Nordic countries (27 million people) than from sub‐Saharan Africa and South Asia regions combined (2.9 billion people). Finally, one‐third of the empirical articles did not indicate the country of evidence in the title or the abstract, possibly to signal external validity of the findings. This practice was particularly common for articles based on data from North America with more than half of the articles omitting the country of evidence from the title and the abstract. The study concludes by exploring some hypotheses that may explain these findings.