妇幼卫生与社区卫生服务──确定卫生问题及干预方法

在进行社区妇幼卫生服务时，确定卫生问题和干预方法是关系到卫生服务质量的关键部分。本文介绍了通过对卫生资料的收集、卫生信息的分析、卫生状况的评估及确定优先领域来确定卫生问题及干预方法。优先领域即重点问题在不同地区各不相同，应根据当地情况和资源来设计干预措施，解决主要问题。     

改善卫生服务公平性的选择与尝试

为改善卫生服务的公平性，中国在同世界银行、英国国际发展部、福特基金、美国中华基金合作的“中国基本卫生服务项目”（卫生Ⅷ项目）中，采用了3种方式确定卫生资源的投入方向和服务提供策略，以保证弱势群体获得最基本的卫生服务。（1）地域确定方式：在选定的贫困地区，即贫困省份中的贫困县，投资于卫生基础设施建设，培训卫生人员，提高服务提供能力和质量；（2）服务确定方式；针对当地的主要卫生问题，补贴重点卫生干预，特别是预防服务；（3）家庭确定方式：通过民主程序，确定最贫困的家庭，针对其最基本的需求，为他们提供减免费用的基本卫生服务。对3种方式的试点效果和特征进行了初步分析。     

利用CHNRI方法确定中国卫生政策优先研究问题

目的:运用儿童健康与营养研究(Children Health and Nutrition Research Initiative,CHNRI)方法,确定我国优先干预的卫生问题,为卫生政策制定者提供循证决策依据。方法:以我国医改与卫生事业发展"十二五"规划为背景资料,通过文献分析从中筛选出多项卫生政策研究问题,并采用CHNRI项目开发的设定优先研究领域的工具和方法进行优先问题选择。结果与讨论:研究筛选出的前10位优先研究问题主要集中在以下几方面:公共卫生服务相关研究、卫生经费的筹资及利用、重点人群和重点地区卫生政策相关研究、卫生信息化建设、医疗质量控制等,建议政府应在"十三五"期间加强有关问题的研究与干预。利用CHNRI方法确定卫生政策优先研究问题可行且有效,可为决策者提供循证依据。     

常熟市卫生资源现状调查与分析

目的：通过对常热市2003年卫生人力资源、卫生物力资源、卫生财力资源及医疗机构卫生服务供给情况等方面卫生资源情况的分析，为制定常熟市区域卫生规划提供基础性的数据，促进卫生体制改革的进程。方法：采用普查方法，对常熟市卫生资源各项指标的绝对数、均数及其构成比等进行描述性统计分析，并与苏州市、全省总体水平进行比较。结果：2003年全市共有各类医疗卫生机构473个，共有床位3318张，卫生工作人员6224名。每千人口拥有卫技人员4．14人，全市医护比为1：0．62；每千人口拥有3．20张床位；医疗机构业务收入主要以药品收入为主；人均卫生事业经费迭81．44元；住院人数及手术人次数均以市属医院为高，分别占全市的52．97％和73．41％。结论：卫生资源存量丰富，各类医疗卫生机构配备齐全；卫生资源结构配置不合理；医疗机构基本能收支平衡，业务收入结构不舍理；卫生技术人员中严重缺乏护理人员。     

上海市卫生研究系统管理分析及改进建议

通过文献评阅和关键知情人访谈，了解目前上海市卫生研究系统的管理构架和领导能力，包括制定研究优先领域、伦理委员会建设、卫生研究管理法规、信息管理等方面的情况。研究发现卫生研究管理方面的一些薄弱环节，建议卫生研究系统加强对优先领域的投资、加强卫生研究法规建设与信息建设等。     

项目预算与边际分析方法简介

本文介绍一种将经济学理论应用于卫生资源配置的方法———项目预算与边际分析 (ＰｒｏｇｒａｍＢｕｄｇｅｔｉｎｇ ａｎｄＭａｒｇｉｎａｌＡｎａｌｙｓｉｓ，ＰＢＭＡ)。项目预算的任务是对现有卫生资源在项目内和项目间的分布进行评价 ,这些评价资料可与区域卫生需要信息一起 ,确定在卫生服务领域中对服务项目投入的变动。由于资源是一定的 ,对某一项卫生服务活动增加投入将引起同一项目或另外项目中其它卫生服务活动的减少 ;对需要更多资源投入的候选项目与减少投入的候选项目进行比较 ,以确定是否值得作出这种改变或哪种变动应优先进行…     

湖南省精神卫生服务现状及对策研究

目的分析2002年湖南省精神卫生机构服务现状，为卫生职能部门制定精神卫生工作规划提供参考。方法采用描述性的分析方法，对湖南省2002年精神卫生机构的服务现状进行分析。结果湖南省精神卫生机构资源比较贫乏，同时卫生资源利用率较低。结论建立精神卫生管理机构；增加卫生资源投入；加强专业人员的培训；坚持专科发展方向，不断拓宽相关专科服务领域；开展社区精神病防治。     

长沙市卫生资源配置现状分析

目的：通过对长沙市2001年卫生机构、医院病床、卫生人力、医疗设备以及卫生事业经费等5个基本方面卫生资源存量的分析，为制定我市卫生规划提供参考。方法：对长沙市城、乡各级各类医疗机构卫生资源的各项指标进行绝对数、均数、百分构成统计描述分析；并与全省、全国平均水平及其他城市卫生资源状况进行比较分析。结论：卫生资源较丰富；分布不合理，缺乏统一管理；政府投入不足，医疗收入结构不合理；卫技人员数量多，但内部结构不尽合理。建议：调整卫生资源存量，合理布局；加强卫生全行业管理；加大资金投入力度，改变资金投入方式；调整卫生资源的人力结构，开发人才资源，保持卫生人力资源的适度增长和合理配置。     

28个卫生Ⅷ项目县基本卫生状况分析

通过对２８个卫生Ⅷ项目基本卫生状况分析,认为２８个县卫生资源匮乏,卫生投入不足;居民健康水平低于全国平均水平,农民人均收对贫困地区居民健康状况影响较大;预防保健工作水平对贫困地区居民健康状况影响较大;建议：加强卫生投入,提高卫生服务的提供和服务质量;合理配置有限的卫生资源,提高资源的利用效率;确定优先干预重点,提高卫生服务需方的利用能力。     

基于卫生交流合作视角的“一带一路”沿线国家分类指标体系研究

目的：构建基于卫生交流合作视角的"一带一路"沿线国家分类指标体系，以便对沿线国家进行合理分类。方法：通过文献研究构建初始的分类指标体系，采用Delphi法对初始指标进行筛选；运用层次分析法确定指标权重。结果：确立了国家分类指标体系，包括一级指标4个：卫生需要与供给、贸易现况与潜力、双边关系、合作风险；二级指标25个，如五岁以下儿童死亡率、双边传统药物进出口总额、高层互访次数、文化差异等。结论：本研究构建的指标体系可以为政府部门选取卫生合作的优先对象或重点领域、医药企业采取合适的经营策略、相关学者开展后续研究提供参考。     

国外卫生资源分配的公众参与研究：基于卫生优先级制定理论的思考

卫生资源合理分配是卫生政策制定的难题之一,卫生优先级制定理论为此提供解决方法。优先级制定所涉及的公众参与理论研究,将有助于增强我国卫生资源分配政策制定的透明度和有效性。     

Qualitative methodologies in health-care priority setting research

Priority setting research in health economics has traditionally employed quantitative methodologies and been informed by post-positivist philosophical assumptions about the world and the nature of knowledge. These approaches have been rewarded with well-developed and validated tools. However, it is now commonly noted that there has been limited uptake of economic analysis into actual priority setting and resource allocation decisions made by health-care systems. There seem to be substantial organizational and political barriers. The authors argue in this paper that understanding and addressing these barriers will depend upon the application of qualitative research methodologies. Some efforts in this direction have been attempted; however these are theoretically under-developed and seldom rooted in any of the established qualitative research traditions. Two such approaches - narrative inquiry and discourse analysis - are highlighted here. These are illustrated with examples drawn from a real-world priority setting study. The examples demonstrate how such conceptually powerful qualitative traditions produce distinctive findings that offer unique insight into organizational contexts and decision-maker behavior. We argue that such investigations offer untapped benefits for the study of organizational priority setting and thus should be pursued more frequently by the health economics research community.     

The Evolution of PBMA: Towards a Macro-Level Priority Setting Framework for Health Regions

To date, relatively little work on priority setting has been carried out at a macro-level across major portfolios within integrated health care organizations. This paper describes a macro marginal analysis (MMA) process for setting priorities and allocating resources in health authorities, based on work carried out in a major urban health region in Alberta, Canada. MMA centers around an expert working group of managers and clinicians who are charged with identifying areas for resource re-allocation on an ongoing basis. Trade-offs between services are based on locally defined criteria and are informed by multiple inputs such as evidence from the literature and local expert opinion. The approach is put forth as a significant improvement on historical resource allocation patterns.     

Health research priority setting in selected high income countries: a narrative review of methods used and recommendations for future practice

Research priority setting aims to gain consensus about areas where research effort will have wide benefits to society. While general principles for setting health research priorities have been suggested, there has been no critical review of the different approaches used. This review aims to: (i) examine methods, models and frameworks used to set health research priorities; (ii) identify barriers and facilitators to priority setting processes; and (iii) determine the outcomes of priority setting processes in relation to their objectives and impact on policy and practice.Medline, Cochrane, and PsycINFO databases were searched for relevant peer-reviewed studies published from 1990 to March 2012. A review of grey literature was also conducted. Priority setting exercises that aimed to develop population health and health services research priorities conducted in Australia, New Zealand, North America, Europe and the UK were included. Two authors extracted data from identified studies.Eleven diverse priority setting exercises across a range of health areas were identified. Strategies including calls for submission, stakeholder surveys, questionnaires, interviews, workshops, focus groups, roundtables, the Nominal Group and Delphi technique were used to generate research priorities. Nine priority setting exercises used a core steering or advisory group to oversee and supervise the priority setting process. None of the models conducted a systematic assessment of the outcomes of the priority setting processes, or assessed the impact of the generated priorities on policy or practice. A number of barriers and facilitators to undertaking research priority setting were identified.The methods used to undertake research priority setting should be selected based upon the context of the priority setting process and time and resource constraints. Ideally, priority setting should be overseen by a multi-disciplinary advisory group, involve a broad representation of stakeholders, utilise objective and clearly defined criteria for generating priorities, and be evaluated.     

如何确定医学研究的优先资助领域--来自世界卫生组织的经验

如何制定医学研究的优先资助领域是目前健康政策和科研规划研究的热点之一。十多年来世界卫生组织在全球范围内开展了大量的相关研究，积累了丰富的经验。本从资料收集、评价标准和参与人员三个方面介绍了世界卫生组织参与开发和推广的三种制定优先资助领域方法，比较了它们间的异同和存在的问题，供我们学习和借鉴。     

The public and professional interface with priority setting in the National Health Service

The agenda of purchasers of health care in the National Health Service (NHS) is increasingly dominated by the issue of priority setting. This is a consequence of the interplay of limited budgets, increasing demands on health care services and a contracting process that makes explicit resource decisions that were previously implicit through clinical discretion. Purchasers are increasingly concerned to show that their decisions are rationally informed and embody a professional and public consensus. This paper examines literature that suggests variables, other than rational determinants, play a part in the process of priority setting at the purchaser and provider level. The interface of public, political and professional agendas in this process help explain the lack of national uniformity in both setting priorities and their translation into practice. Consequently, there is a need for more comprehensive exploration of the relationship between the setting of priorities and their effect on practice.     

Healthcare priority setting in Kenya: a gap analysis applying the accountability for reasonableness framework

In resource‐poor settings, the accountability for reasonableness (A4R) has been identified as an important advance in priority setting that helps to operationalize fair priority setting in specific contexts. The four conditions of A4R are backed by theory, not evidence, that conformance with them improves the priority setting decisions. This paper describes the healthcare priority setting processes in Malindi district, Kenya, prior to the implementation of A4R in 2008 and evaluates the process for its conformance with the conditions for A4R. In‐depth interviews and focus group discussions with key players in the Malindi district health system and a review of key policy documents and national guidelines show that the priority setting process in the district relies heavily on guidelines from the national level, making it more of a vertical, top‐down orientation. Multilateral and donor agencies, national government, budgetary requirements, traditions and local culture influence the process. The four conditions of A4R are present within the priority setting process, albeit to varying degrees and referred to by different terms. There exists an opportunity for A4R to provide a guiding approach within which its four conditions can be strengthened and assessed to establish whether conformance helps improve on the priority setting process. Copyright © 2013 John Wiley & Sons, Ltd.     

Priority setting using multiple criteria: should a lung health programme be implemented in Nepal?

OBJECTIVES: To identify and weigh the various criteria for priority setting, and to assess whether a recently evaluated lung health programme in Nepal should be considered a priority in that country. METHODS: Through a discrete choice experiment with 66 respondents in Nepal, the relative importance of several criteria for priority setting was determined. Subsequently, a set of interventions, including the lung health programme, was rank ordered on the basis of their overall performance on those criteria. RESULTS: Priority interventions are those that target severe diseases, many beneficiaries and people of middle-age, have large individual health benefits, lead to poverty reduction and are very cost-effective. Certain interventions in tuberculosis control rank highest. The lung health programme ranks 13th out of 34 interventions. CONCLUSION: This explorative analysis suggests that the lung health programme is among the priorities in Nepal when taking into account a range of relevant criteria for priority setting. The multi-criteria approach can be an important step forward to rational priority setting in developing countries.     

A checklist for health research priority setting: nine common themes of good practice

Health research priority setting processes assist researchers and policymakers in effectively targeting research that has the greatest potential public health benefit. Many different approaches to health research prioritization exist, but there is no agreement on what might constitute best practice. Moreover, because of the many different contexts for which priorities can be set, attempting to produce one best practice is in fact not appropriate, as the optimal approach varies per exercise. Therefore, following a literature review and an analysis of health research priority setting exercises that were organized or coordinated by the World Health Organization since 2005, we propose a checklist for health research priority setting that allows for informed choices on different approaches and outlines nine common themes of good practice. It is intended to provide generic assistance for planning health research prioritization processes. The checklist explains what needs to be clarified in order to establish the context for which priorities are set; it reviews available approaches to health research priority setting; it offers discussions on stakeholder participation and information gathering; it sets out options for use of criteria and different methods for deciding upon priorities; and it emphasizes the importance of well-planned implementation, evaluation and transparency.