体医结合项目的经济学评价现况分析

Status quo and analysis of economic evaluation of integrated sports and medicine

《“健康中国2030”规划纲要》明确提出,要“推动形成体医结合的疾病管理与健康服务模式”,伴随国家政策层面对体医结合的大力推进,我国各地日益重视体医结合项目的有关实践。虽然体医结合项目已逐渐开始落实,但囿于客观经济学评价的缺失,致使医保支撑证据不足,可推广性大为受限。本文系统回顾了国内外已有体医结合项目应用于疾病治疗及健康维护相关目的的经济学评价案例,发现评价项目主要针对有氧运动、抗阻训练、太极拳、足球、组合运动(有氧、力量、平衡性、柔韧性训练)等基础运动项目,并且当前体医结合项目的经济学评价以成本-效果分析为主,多以质量调整生命年和特定疾病的临床指标为健康产出,剖析得到我国当前体医结合项目的经济学评价研究瓶颈,包括:缺乏针对同一研究目的,相同视角下成本核算、健康产出指标的统一规范;尚未对体医结合项目的干预时长和研究时限进行统一;缺乏对项目运动强度的科学性评估;以质量调整生命年为健康产出的核算方法存在一定程度的应用受限等。综合当前我国体医结合项目现况及上述问题,提出相关建议:在进行体医结合项目的经济学评价时,应加强真实世界多元化数据的收集,利用健康信息大数据改良经济学模型,并强化其在体医结合项目评价中的应用。

The initiatives that promote and shape the disease management and healthcare service models that combine sports and medicine have been put forward in the Plan of Health China 2030.Health organizations across the country have been paying increasing attention to the combination of sports and medicine,with the encouragement of national policy.However,due to the lack of economic evaluations,there is still short of supporting evidence and practical application in this area.This paper reviews the economic evaluation cases of integrated sports and medicine programs in foreign countries.We find that the programs are mainly focus on some traditional sports,such as aerobic exercise,resistance exercise and Tai Chi.Cost-effectiveness analysis is now the primary method,with quality-adjusted life years and disease-specific clinical outcomes as health output indicators.The bottlenecks in the current studies include the diverse definitions of cost accounting and health output indicators,the lack of uniformity in the length of intervention and evaluation periods,the unscientific assessment of exercise intensity and the limited use of quality-adjusted life years in this method.We suggested collecting pluralistic data in the real world and strengthening the application of the economic evaluation models based on the big data.