卫生资源优先次序分配的政府治理研究——国际研究述评及对我国的启示

Governance on priority setting of health resource allocation: International research review and its implication for China

卫生资源优先次序分配作为政府有效治理的重要领域,在我国仍缺乏类似层面的综合思考。西方在该领域的研究趋势已从单纯的经济学思考走向了政治经济学、制度约束、卫生筹资的全面分析,并在更宏大的组织和政治情境中,考量政府的治理范围、手段,建构操作性强的优先次序分配框架。在卫生决策实践中,找寻跨学科工具的最佳组合考验着决策者的治理水平。本文梳理政治学、卫生经济学、哲学、法学、循证医学等不同学科对卫生资源优先次序分配的思考。最后明确政府卫生资源治理的层次、治理策略建议,强调卫生决策从"作为结构的治理"走向"作为过程的治理"的发展规律因应我国所面临的挑战。

Priority setting of health resource allocation depends on effective and comprehensive governmentbased stewardship,the national research of which lacks comprehensive considerations. The paper articulates the trend of western research from solo economic analysis to a combined comprehension of political economies,systemic constraints and health financing,to consider the scope,strategy and enforced framework for government rationing within a larger organizational and political context. In the health decision-making practice,the best formula for interdisciplinary tools is a test of stewardship capacity. A multi-disciplinary approach from the perspectives of politics,health economies,philosophy,law and evidence-based medicine must be adopted for the priority setting of health resource allocation. Finally,a clear stewardship phased objective is proposed as well as strategies,with emphasis on health decisions from ＂stewardship as structure＂to ＂stewardship as a process＂with challenges that lie ahead.