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Scaling Up Departmental Health Insurance Units in Senegal: A Mixed-Method Study. 在塞内加尔扩大部门医疗保险单位:混合方法研究。
Pub Date : 2024-12-16 Epub Date: 2024-09-30 DOI: 10.1080/23288604.2024.2402084
Valéry Ridde, Mouhamadou Faly Ba, Babacar Kane, Anouk Chouaïd, Adama Faye

In response to the failure of community-based health insurance (CBHI) at the municipal level, some African countries are implementing district or departmental CBHIs to improve universal health coverage. After creating two CBHIs at the departmental level in 2014, Senegal launched a campaign to disseminate the model in 2022. This article presents the stakeholders' perspectives on the factors and challenges of scaling up CBHI departmentalization in Senegal. The study uses a mixed-methods approach, utilizing concept mapping and a focus group to examine scaling up departmentalization. The sample size consists of 22 individuals involved in the process. The quantitative analysis includes hierarchical cluster analysis, multidimensional scaling analysis, and the Pearson coefficient test. The qualitative analysis involves content analysis to triangulate the findings. Participants identified 125 factors to consider for the departmentalization of CBHI. They were categorized into nine clusters according to their degree of importance (I) and ease to organize (F): service package (I: 4.07; F: 2,26), communication (I: 4.05; F: 2.96), governance (I: 3.96; F: 2,94), human and logistical resources (I: 3.94; F: 2,82), financing (I: 3.90; F: 2,31), involvement of the authorities (I: 3.82; F: 2.75), community involvement (I: 3.81; F: 2.76), membership (I: 3.70; F: 2.24, strategic planning and implementation (I: 3.57; F: 2,62). The main challenges faced were a process perceived as precipitous and vertical and needing more negotiation and consultation. The conditions for accompaniment and public funding availability need to be sufficiently considered. The study proposes avenues for action to promote the scaling up of CBHI departmentalization in Senegal.

针对市级社区医疗保险(CBHI)的失败,一些非洲国家正在实施区级或省级社区医疗保险,以提高全民医保覆盖率。塞内加尔在 2014 年建立了两个省级社区医疗保险机构后,又发起了一场运动,希望在 2022 年推广这一模式。本文从利益相关者的角度阐述了在塞内加尔推广社区健康倡议部门化的因素和挑战。本研究采用混合方法,利用概念图和焦点小组来研究扩大部门化的问题。样本量由参与该过程的 22 人组成。定量分析包括层次聚类分析、多维尺度分析和皮尔逊系数检验。定性分析包括内容分析,以便对研究结果进行三角测量。参与者确定了 125 个社区保健倡议部门化的考虑因素。根据其重要程度(I)和组织难易程度(F),这些因素被分为九组:一揽子服务(I: 4.07; F: 2,26)、沟通(I: 4.05; F: 2.96)、管理(I: 3.96; F: 2,94)、人力和后勤资源(I: 3.94; F: 2,82), financing (I: 3.90; F: 2,31), involvement of the authorities (I: 3.82; F: 2.75), community involvement (I: 3.81; F: 2.76), membership (I: 3.70; F: 2.24), strategic planning and implementation (I: 3.57; F: 2,62).所面临的主要挑战是,这一进程被认为是仓促和垂直的,需要更多的谈判和协商。需要充分考虑陪同的条件和公共资金的可用性。本研究提出了促进塞内加尔扩大社区保健倡议部门化的行动途径。
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引用次数: 0
Battle to Survive: The Association Between Accountability and Chinese Local Government Response to COVID-19. 为生存而战:问责制与中国地方政府应对 COVID-19 的关联》。
Pub Date : 2024-12-16 Epub Date: 2024-09-30 DOI: 10.1080/23288604.2024.2400725
Bingqing Guo, Karen Ann Grépin

China's ability to sustain the zero-COVID strategy over three years has garnered global attention, but little is known about the factors contributing to its long-term adherence. Based on the political promotion tournament model, this article theorizes that China's strict administrative accountability system, which tied local officials' career prospects to their performance in crucial policy goals, incentivized local governments to sustain COVID-19 policies. Using data from the Oxford COVID-19 Government Response Tracker and major official Chinese media outlets, we performed interrupted time series analysis (ITSA) to examine whether the accountability events affected the local government's COVID-19 responses. Noticeably, our analyses found that from May 4, 2020, to September 30, 2022, when an accountability event happened, officials in the affected (local effects) and unaffected (spillover effects) provinces all increased their containment responses and decreased their economic support responses. This is true even for provinces without new localized outbreaks. The effects of accountability events increased with decreasing geographical distance. These findings remain consistent after several robustness checks. The administrative accountability system is a key institutional factor in implementing China's zero-COVID strategy, which contributed to the global literature about the pandemic policy process in centralized countries.

中国在三年内坚持零加征增值税战略的能力引起了全球关注,但人们对促成其长期坚持的因素却知之甚少。基于政治晋升锦标赛模型,本文推论中国严格的行政问责制度将地方官员的职业前景与他们在关键政策目标上的表现挂钩,从而激励地方政府维持 COVID-19 政策。利用牛津大学 COVID-19 政府回应追踪系统和中国主要官方媒体的数据,我们进行了中断时间序列分析(ITSA),以研究问责事件是否影响了地方政府的 COVID-19 回应。值得注意的是,我们的分析发现,从 2020 年 5 月 4 日到 2022 年 9 月 30 日,当问责事件发生时,受影响(本地效应)和未受影响(溢出效应)省份的官员都增加了遏制对策,减少了经济支持对策。即使在没有发生新的局部疫情的省份也是如此。问责事件的影响随着地理距离的减小而增加。经过多次稳健性检验后,这些发现仍然一致。行政问责制度是中国实施零COVID战略的关键制度因素,它为有关中央集权国家大流行政策过程的全球文献做出了贡献。
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引用次数: 0
Roles and Dynamics within Community Mental Health Systems During the COVID-19 Pandemic: A Qualitative Systematic Review and Meta-Ethnography. COVID-19 大流行期间社区心理健康系统中的角色和动态:定性系统综述和 Meta-Ethnography。
Pub Date : 2024-04-10 DOI: 10.1080/23288604.2024.2314525
Cheryl Su Ling Sim, P. Asharani, Mythily Subramaniam, Huso Yi
Globally, COVID-19 had an immense impact on mental health systems, but research on how community mental health (CMH) systems and services contributed to the pandemic mental health response is limited. We conducted a systematic review and meta-ethnography to understand the roles of CMH services, determinants of the quality of CMH care, and dynamics within CMH systems during COVID-19. We searched and screened across five databases and appraised study quality using the CASP tool, which yielded 27 qualitative studies. Our meta-ethnographic process used Noblit and Hare's approach for synthesizing findings and applying interpretive analysis to original research. This identified several key themes. Firstly, CMH systems played the valuable pandemic role of safety nets and networks for the broader mental health ecosystem, while CMH service providers offered a continuous relationship of trust to service users amidst pandemic disruptions. Secondly, we found that the determinants of quality CMH care during COVID-19 included resourcing and capacity, connections across service providers, customized care options, ease of access, and human connection. Finally, we observed that power dynamics across the CMH landscape disproportionately excluded marginalized groups from mainstream CMH systems and services. Our findings suggest that while the pandemic role of CMH was clear, effectiveness was driven by the efforts of individual service providers to meet demand and service users' needs. To reprise its pandemic role in the future, a concerted effort is needed to make CMH systems a valuable part of countries' disaster mental health response and to invest in quality care, particularly for marginalized groups.
在全球范围内,COVID-19 对精神卫生系统产生了巨大的影响,但有关社区精神卫生(CMH)系统和服务如何促进大流行性精神卫生应对措施的研究却十分有限。我们开展了一项系统性综述和元民族志研究,以了解在 COVID-19 期间社区精神卫生服务的作用、社区精神卫生护理质量的决定因素以及社区精神卫生系统内部的动态变化。我们在五个数据库中进行了搜索和筛选,并使用 CASP 工具对研究质量进行了评估,最终得出了 27 项定性研究。我们采用 Noblit 和 Hare 的元人种学方法对研究结果进行综合,并将解释性分析应用于原创研究。这确定了几个关键主题。首先,精神卫生中心系统在大流行期间为更广泛的精神卫生生态系统发挥了安全网和网络的重要作用,而精神卫生中心的服务提供者则在大流行期间为服务使用者提供了持续的信任关系。其次,我们发现,在 COVID-19 期间,优质 CMH 医疗服务的决定因素包括资源和能力、服务提供者之间的联系、定制化的医疗服务选择、获取服务的便利性以及人与人之间的联系。最后,我们注意到,在整个医疗保健行业中,权力动态将边缘化群体过度排斥在主流医疗保健系统和服务之外。我们的研究结果表明,虽然社区医疗中心在大流行病中的作用是显而易见的,但其有效性则取决于各个服务提供者为满足需求和服务使用者的需要而做出的努力。要想在未来的大灾难中重新发挥其作用,就需要各方共同努力,使社区医疗卫生系统成为各国灾难心理健康应对措施的重要组成部分,并投资于高质量的医疗服务,尤其是针对边缘化群体的医疗服务。
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引用次数: 0
Effect of the Implementation of the French Hospital Regionalization Policy on Patient Mobility. 法国医院区域化政策的实施对患者流动性的影响。
Pub Date : 2023-12-31 Epub Date: 2023-10-27 DOI: 10.1080/23288604.2023.2267256
Jan Chrusciel, Marie-Caroline Clément, Sandra Steunou, Thierry Prost, Antoine Duclos, Stéphane Sanchez

A new law was voted in France in 2016 to increase cooperation between public sector hospitals. Hospitals were encouraged to work under the leadership of local referral centers and to share their support functions (e.g., information systems) with newly created hospital groups, called "Regional Hospital Groups." The law made it compulsory for each public sector hospital to become affiliated with one of 136 newly created hospital groups. The policy's aim was to ensure that all patients were sent to the hospital best qualified to treat their unique condition, among the hospitals available at the regional level. Therefore, we aimed to assess whether this regionalization policy was associated with changes in observed patterns of patient mobility between hospitals. This nationwide observational study followed an interrupted time series design. For each stay occurring from 2014 to 2019, we ascertained whether or not the stay was followed by mobility toward another hospital within 90 days, and whether or not the receiving hospital was part of the same Regional Hospital Group as the sender hospital. The proportion of mobility directed toward the same regional hospital group increased from 22.9% in 2014 (95% CI 22.7-23.1) to 24.6% in 2019 (95% CI 24.4-24.8). However, the absence of discontinuity during the policy change year was consistent with the hypothesis of a preexisting trend toward regionalization. Therefore, the policy did not achieve major changes in patterns of mobility between hospitals. Other objectives of the reform, including long-term consequences on the healthcare offer, remain to be assessed.

2016年,法国投票通过了一项新法律,以加强公共部门医院之间的合作。鼓励医院在当地转诊中心的领导下工作,并与新成立的医院集团(称为“地区医院集团”)共享其支持功能(如信息系统)。法律规定,每个公共部门医院都必须隶属于136个新成立的医院集团之一。该政策的目的是确保所有患者都被送往地区级医院中最有资格治疗其独特疾病的医院。因此,我们旨在评估这种区域化政策是否与观察到的医院间患者流动模式的变化有关。这项全国性的观察性研究采用了中断时间序列设计。对于2014年至2019年的每一次住院,我们都确定了住院后是否在90天内前往另一家医院 天,以及接收医院是否与发送医院属于同一地区医院集团。流向同一地区医院群的流动比例从2014年的22.9%(95%CI 22.7-23.1)增加到2019年的24.6%(95%CI 24.4-24.8)。然而,政策变化年没有间断性,这与先前存在的区域化趋势的假设一致。因此,该政策没有实现医院之间流动模式的重大变化。改革的其他目标,包括对医疗服务的长期影响,仍有待评估。
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引用次数: 0
Institutionalizing Health Technology Assessment in Ghana: Enablers, Constraints, and Lessons. 加纳卫生技术评估的制度化:推动因素、制约因素和经验教训。
Pub Date : 2023-12-31 Epub Date: 2024-05-07 DOI: 10.1080/23288604.2024.2314519
Augustina Koduah, Jessica Anim Boadi, Joycelyn Naa Korkoi Azeez, Brian Adu Asare, Saviour Yevutsey, Martha Gyansa-Lutterodt, Justice Nonvignon

Health Technology Assessment (HTA) has been institutionalized in Ghana with structures, processes, and methods. This paper identifies and analyzes the policy players involved; the way in which issues were framed; and the manner in which administrative structures were used to set the agenda for, adopt, and implement HTA. It shows that the Ministry of Health, supported by other players, led HTA agenda-setting through training activities and discussions on evidence of selection pharmaceuticals, medical devices, and other health-related technologies. HTA was then captured in a health sector aide memoire that summarized the decisions made at a national health summit. In implementing the HTA policy, technical working groups and a steering committee were constituted to provide recommendations to the minister of health on high-level decisions. The ability of agenda influencers to maneuver existing administrative and bureaucratic structures, align them with national strategic goals, and sustain HTA implementation enabled Ghana to institutionalize HTA. Limited financial support and a dearth of in-country expertise are being addressed through capacity building and funding. To ensure early national buy-in and uptake, policy makers and agenda influencers need to understand each country's health system and align HTA with national policy decision-making processes.

在加纳,卫生技术评估 (HTA) 已通过结构、流程和方法实现制度化。本文确定并分析了所涉及的政策参与者;问题的提出方式;以及利用行政结构制定、通过和实施 HTA 议程的方式。报告显示,卫生部在其他参与者的支持下,通过培训活动和讨论选择药品、医疗器械和其他健康相关技术的证据,领导了 HTA 议程的制定。然后,HTA 被纳入卫生部门备忘录,该备忘录总结了全国卫生峰会上做出的决定。在实施 HTA 政策的过程中,成立了技术工作组和指导委员会,就高层决策向卫生部长提出建议。议程影响者有能力操纵现有的行政和官僚结构,使其与国家战略目标保持一致,并维持 HTA 的实施,这使加纳得以将 HTA 制度化。目前正在通过能力建设和资金筹措来解决财政支持有限和国内专业人才匮乏的问题。为确保国家尽早接受和采纳,决策者和议程影响者需要了解每个国家的卫生系统,并使 HTA 与国家政策决策过程保持一致。
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引用次数: 0
Introduction to the Special Issue on "Building Institutions for Priority Setting in Health". 关于 "建立确定卫生优先事项的机构 "特刊的导言。
Pub Date : 2023-12-31 Epub Date: 2024-08-05 DOI: 10.1080/23288604.2024.2377891
Victoria Y Fan, Javier Guzman, Pete Baker

In the pursuit of universal health coverage, countries are invariably confronted with questions about which services to pay with public funds, to whom, and at what cost. Such priority-setting processes have major ramifications for the costs and benefits of care delivered. These processes are not just technical, but also highly political and organizational in nature and expressions of social values. This special issue focuses on building institutions for priority setting in health. These institutions serve a public purpose and are primarily concerned with conducting or using health technology assessment (HTA) to inform resource allocation decisions. We first define the concept of institutions for priority setting in health and the methodological considerations of assessing and evaluating these institutions. Next, we present key common themes and summarize key messages across the articles, including lessons learned and future challenges in building these institutions.

在追求全民医保的过程中,各国总会遇到用公共资金支付哪些服务、支付给谁、成本是多少的问题。这种确定优先事项的过程对所提供的医疗服务的成本和效益具有重大影响。这些过程不仅是技术性的,也是高度政治性和组织性的,是社会价值观的体现。本特刊的重点是建立确定医疗卫生优先事项的机构。这些机构服务于公共目的,主要关注开展或使用卫生技术评估 (HTA) 为资源分配决策提供信息。我们首先定义了卫生领域优先事项设定机构的概念,以及评估和评价这些机构的方法论考虑因素。接下来,我们介绍了这些文章的主要共同主题并总结了其中的关键信息,包括在建立这些机构方面的经验教训和未来挑战。
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引用次数: 0
Fifteen Lessons from Fifteen Years of the Health Intervention and Technology Assessment Program in Thailand. 泰国卫生干预和技术评估计划十五年来的十五条经验。
Pub Date : 2023-12-31 Epub Date: 2024-05-07 DOI: 10.1080/23288604.2024.2330974
Yot Teerawattananon, Saudamini Vishwanath Dabak, Anthony Culyer, Anne Mills, Pritaporn Kingkaew, Wanrudee Isaranuwatchai

The Health Intervention and Technology Assessment Program (HITAP) was established in 2007. This article highlights 15 lessons from over 15 years of experience, noting five achievements about what HITAP has done well, five areas that it is currently working on, and five aims for work in the future. HITAP built capacity for HTA and linked research to policy and practice in Thailand. With collaborators from academic and policy spheres, HITAP has mobilized regional and global support, and developed global public goods to enhance the field of HTA. HITAP's semi-autonomous structure has facilitated these changes, though they have not been without their challenges. HITAP aims to continue its work on HTA for public health interventions and disinvestments, effectively engaging with stakeholders and strategically managing its human resources. Moving forward, HITAP will develop and update global public goods on HTA, work on emerging topics such as early HTA, address issues in digital health, real-world evidence and equity, support HTA development globally, particularly in low-income settings, and seek to engage more effectively with the public. HITAP seeks to learn from its experience and invest in the areas identified so that it can grow sustainably. Its journey may be relevant to other countries and institutions that are interested in developing HTA programs.

健康干预与技术评估计划 (HITAP) 成立于 2007 年。本文重点介绍了 15 年来的 15 条经验,指出了 HITAP 取得的五项成就、目前正在努力的五个领域以及未来工作的五个目标。HITAP 建设了泰国的 HTA 能力,并将研究与政策和实践联系起来。HITAP 与学术和政策领域的合作者一起,动员了地区和全球的支持,并开发了全球公共产品,以加强 HTA 领域。HITAP 的半自治结构促进了这些变革,尽管其中也不乏挑战。HITAP 的目标是继续为公共卫生干预和取消投资开展 HTA 工作,有效地与利益相关方合作,并对其人力资源进行战略管理。展望未来,HITAP 将开发和更新有关 HTA 的全球公共产品,研究早期 HTA 等新兴课题,解决数字健康、真实世界证据和公平方面的问题,支持全球 HTA 的发展,特别是在低收入环境中,并寻求更有效地与公众接触。HITAP 努力汲取经验,并在已确定的领域进行投资,从而实现可持续发展。它的发展历程可能对其他有意发展 HTA 计划的国家和机构有借鉴意义。
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引用次数: 0
Institutionalizing Health Technology Assessment and Priority Setting in South Korea's Universal Health Coverage Journey. 在韩国的全民医保进程中实现卫生技术评估和优先事项设定的制度化。
Pub Date : 2023-12-31 Epub Date: 2024-05-07 DOI: 10.1080/23288604.2024.2338308
Juhwan Oh, Min-Jeong Kim, Sujeong Hur, Juyeon Oh, Dong-Sook Kim

This study charts the chronological developments of the three institutions that were established in South Korea for priority setting in health. In 2007, the Evidence-based Medicine Team and the Center for New Health Technology Assessment (CnHTA) were established and nested in the Health Insurance Review and Assessment Service (HIRA). In December 2008, the National Evidence-based Healthcare Collaborating Agency (NECA) was launched, to which the CnHTA was transferred in 2010. Since then, non-drug technologies have been reviewed by NECA and drugs have been reviewed by HIRA. Political debates about how to embrace expensive but important health technologies that were not on the benefits list led to the creation of the Participatory Priority Setting Committee (PPSC) in 2012. The PPSC, led by the general public, has played a key role in advancing the path toward universal health coverage by revitalizing the list of essential, yet previously overlooked, medical technologies. PPSC offers these technologies a second chance at coverage. HIRA and NECA served to strengthen evidence-based and efficiency-based decision-making in the health system via CnHTA, and PPSC served to strengthen social value-based decision making via priority setting in Korea. The reassessment by PPSC may be relevant in countries where the economy is growing and citizens want to rapidly expand the benefits list.

本研究按时间顺序介绍了韩国为确定卫生优先事项而成立的三个机构的发展情况。2007 年,循证医学小组和新卫生技术评估中心(CnHTA)成立,隶属于健康保险审查与评估服务局(HIRA)。2008 年 12 月,国家循证医疗保健合作机构(NECA)成立,2010 年,新卫生技术评估中心转入该机构。从那时起,非药物技术由 NECA 负责审查,药物则由 HIRA 负责审查。关于如何接受不在效益清单上的昂贵但重要的卫生技术的政治辩论促使参与式优先事项制定委员会(PPSC)于 2012 年成立。参与式优先事项制定委员会由公众领导,通过重振以前被忽视的基本医疗技术清单,在推进全民医保的道路上发挥了关键作用。PPSC 为这些技术提供了第二次获得医保的机会。HIRA 和 NECA 通过 CnHTA 加强了卫生系统中以证据为基础和以效率为基础的决策,而 PPSC 则通过韩国的优先级设定加强了以社会价值为基础的决策。PPSC 的重新评估可能适用于经济正在增长、公民希望迅速扩大福利清单的国家。
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引用次数: 0
International Partnerships to Develop Evidence-informed Priority Setting Institutions: Ten Years of Experience from the International Decision Support Initiative (iDSI). 发展有实证依据的优先事项制定机构的国际伙伴关系:国际决策支持计划(iDSI)十年经验。
Pub Date : 2023-12-31 Epub Date: 2024-05-07 DOI: 10.1080/23288604.2024.2330112
Peter Baker, Edwine Barasa, Kalipso Chalkidou, Lumbwe Chola, Anthony Culyer, Saudamini Dabak, Victoria Y Fan, Katrine Frønsdal, Lieke Fleur Heupink, Wanrudee Isaranuwatchai, Rahab Mbau, Abha Mehndiratta, Justice Nonvignon, Francis Ruiz, Yot Teerawattananon, Anna Vassall, Javier Guzman

All health systems must set priorities. Evidence-informed priority-setting (EIPS) is a specific form of systematic priority-setting which involves explicit consideration of evidence to determine the healthcare interventions to be provided. The international Decision Support Initiative (iDSI) was established in 2013 as a collaborative platform to catalyze faster progress on EIPS, particularly in low- and middle-income countries. This article summarizes the successes, challenges, and lessons learned from ten years of iDSI partnering with countries to develop EIPS institutions and processes. This is a thematic documentary analysis, structured by iDSI's theory of change, extracting successes, challenges, and lessons from three external evaluations and 19 internal reports to funders. We identified three phases of iDSI's work-inception (2013-15), scale-up (2016-2019), and focus on Africa (2019-2023). iDSI has established a global platform for coordinating EIPS, advanced the field, and supported regional networks in Asia and Africa. It has facilitated progress in securing high-level commitment to EIPS, strengthened EIPS institutions, and developed capacity for health technology assessments. This has resulted in improved decisions on service provision, procurement, and clinical care. Major lessons learned include the importance of sustained political will to develop EIPS; a clear EIPS mandate; inclusive governance structures appropriate to health financing context; politically sensitive and country-led support to EIPS, taking advantage of policy windows for EIPS reforms; regional networks for peer support and long-term sustainability; utilization of context appropriate methods such as adaptive HTA; and crucially, donor-funded global health initiatives supporting and integrating with national EIPS systems, not undermining them.

所有医疗系统都必须确定优先事项。有证据支持的优先事项设定(EIPS)是系统性优先事项设定的一种具体形式,它涉及明确考虑证据,以确定应提供的医疗保健干预措施。国际决策支持倡议(iDSI)成立于 2013 年,作为一个合作平台,旨在促进 EIPS 更快取得进展,尤其是在中低收入国家。本文总结了 iDSI 十年来与各国合作开发 EIPS 机构和流程的成功经验、挑战和教训。这是一篇专题文献分析,以 iDSI 的变革理论为架构,从三份外部评估报告和 19 份给资助者的内部报告中提取成功、挑战和经验教训。我们确定了 iDSI 工作的三个阶段--入选阶段(2013-15 年)、扩大阶段(2016-2019 年)和聚焦非洲阶段(2019-2023 年)。iDSI 建立了一个协调 EIPS 的全球平台,推动了该领域的发展,并为亚洲和非洲的地区网络提供了支持。它促进了在确保高层对 EIPS 的承诺、加强 EIPS 机构和发展卫生技术评估能力方面取得进展。这改进了服务提供、采购和临床护理方面的决策。汲取的主要经验教训包括发展 EIPS 的持续政治意愿的重要性;明确的 EIPS 任务;适合卫生筹资情况的包容性治理结构;对 EIPS 具有政治敏感性并由国家主导的支持,利用 EIPS 改革的政策窗口;促进同行支持和长期可持续性的区域网络;利用适应性 HTA 等适合具体情况的方法;以及至关重要的是,由捐助者资助的全球卫生倡议应支持国家 EIPS 系统并与之整合,而不是破坏它们。
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引用次数: 0
Is it the Right Topic? An Overlooked Stage in the Institutionalization of Health Technology Assessment. 主题正确吗?卫生技术评估制度化过程中一个被忽视的阶段。
Pub Date : 2023-12-31 Epub Date: 2024-05-07 DOI: 10.1080/23288604.2024.2329082
Elizabeth F Peacocke, Lieke Fleur Heupink, Aparna Ananthakrishnan, Katrine B Frønsdal

Producing a Health Technology Assessment (HTA) is resource intensive, therefore, an explicit process for Topic Identification, Selection, and Prioritization (TISP) can optimize the use of limited resources to those HTA topics of national importance. TISP does not have to be complicated, however, a formalized process facilitates HTA recommendations that better align with local priorities. The comprehensiveness of TISP processes varies according to countries' needs and to the types of decisions HTA supports. There may be many relevant considerations for TISP, such as the resources available for allocation within the health system, the number of dedicated personnel to complete HTA, and the number of stakeholders and institutions involved in the decision-making process. In countries where HTA-supported decision-making is well-established, the process for TISP is usually formalized. In settings where HTA is emerging, relatively new, or where there may not be the necessary supporting institutional mechanisms, there is limited normative guidance on how to implement TISP. We argue that developing a clear process for TISP is key when institutionalizing HTA. Moreover, insights and experiences from more formalized HTA systems can provide valuable lessons. In this commentary we discuss three institutional aspects that we believe are vital to TISP: 1) Begin topic selection with a clear link to health system feasibility, 2) Ensure legitimacy and impact through transparent TISP processes, and 3) Include the public from the start to embed patient and public engagement throughout HTA.

编制卫生技术评估 (HTA) 是一项资源密集型工作,因此,一个明确的专题识别、选择和优先排序 (TISP) 流程可以优化有限资源的使用,将其用于那些对国家具有重要意义的 HTA 专题。不过,TISP 不一定要很复杂,正规化的流程有助于提出更符合当地优先事项的 HTA 建议。TISP 流程的全面性因各国的需求和支持 HTA 决策的类型而异。TISP 可能有许多相关的考虑因素,如卫生系统内可分配的资源、完成 HTA 的专职人员数量以及参与决策过程的利益相关者和机构的数量。在由 HTA 支持决策的国家,TISP 的流程通常是正规化的。而在 HTA 刚刚兴起、相对较新或可能没有必要的支持性体制机制的环境中,关于如何实施 TISP 的规范性指导非常有限。我们认为,制定明确的 TISP 流程是实现 HTA 制度化的关键。此外,更正规化的 HTA 系统的见解和经验也能提供宝贵的借鉴。在这篇评论中,我们讨论了我们认为对 TISP 至关重要的三个制度方面:1)在开始选题时就与卫生系统的可行性明确挂钩;2)通过透明的 TISP 流程确保合法性和影响力;以及 3)从一开始就纳入公众,将患者和公众的参与贯穿于 HTA 的始终。
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Health systems and reform
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