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Methods to promote equity in health resource allocation in low- and middle-income countries: an overview

机译:促进低收入国家卫生资源分配股权的方法:概述

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Abstract Unfair differences in healthcare access, utilisation, quality or health outcomes exist between and within countries around the world. Improving health equity is a stated objective for many governments and international organizations. We provide an overview of the major tools that have been developed to measure, evaluate and promote health equity, along with the data required to operationalise them.Methods are organised into four key policy questions facing decision-makers: (i) what is the current level of inequity in health; (ii) does government health expenditure benefit the worst-off; (iii) can government health expenditure more effectively promote equity; and (iv) which interventions provide the best value for money in reducing inequity.Benefit incidence analysis can be used to estimate the distribution of current public health sector expenditure, with geographical resource allocation formulae and health system reform being the main government policy levers for improving equity. Techniques from the economic evaluation literature, such as extended and distributional cost-effectiveness analysis can be used to identify ‘best buy’ interventions from a health equity perspective. A range of inequality metrics, from gap measures and slope indices to concentration indices and regression analysis, can be applied to these approaches to evaluate changes in equity.Methods from the economics literature can provide policymakers with a toolkit for addressing multiple aspects of health equity, from outcomes to financial protection, and can be adapted to accommodate data commonly available in low- and middle-income settings.
机译:摘要在世界各国之间和国家之间存在医疗保健,利用,质量或健康成果的不公平差异。改善健康股权是许多政府和国际组织的陈述。我们概述了为衡量,评估和促进健康权益而制定的主要工具,以及运作它们所需的数据。方法是决策者面临的四个关键政策问题:(i)当前是什么?健康状况不公平; (ii)政府保健支出是否有利于最糟糕的; (iii)政府卫生支出可以更有效地促进股权; (iv)哪些干预措施为减少不平等提供最佳物有所值。合并发病率分析可用于估计当前公共卫生部门支出的分布,地理资源配置公式和卫生系统改革是改善的主要政府政策杠杆公平。来自经济评估文献的技术,例如延长和分配成本效益分析可用于识别卫生股权视角的“百思买”干预措施。从差距措施和坡度指标到集中指数和回归分析的一系列不等量级可以应用于这些方法,以评估股权变化的方法。来自经济学文献的方法可以为决策者提供用于解决健康股权的多个方面的工具包,从结果到金融保护,可以适应适应低收入和中等收入设置中常用的数据。

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