Priority setting of health interventions is often ad-hoc and resources are not used to an optimal extent. Underlying problem is that multiple criteria play a role and decisions are complex. Interventions may be chosen to maximize general population health, to reduce health inequalities of disadvantaged or vulnerable groups, ad/or to respond to life-threatening situations, all with respect to practical and budgetary constraints. This is the type of problem that policy makers are typically bad at solving rationally, unaided. They tend to use heuristic or intuitive approaches to simplify complexity, and in the process, important information is ignored. Next, policy makers may select interventions for only political motives. This indicates the need for rational and transparent approaches to priority setting. Over the past decades, a number of approaches have been developed, including evidence-based medicine, burden of disease analyses, cost-effectiveness analyses, and equity analyses. However, these approaches concentrate on single criteria only, whereas in reality, policy makers need to make choices taking into account multiple criteria simultaneously. Moreover, they do not cover all criteria that are relevant to policy makers. Therefore, the development of a multi-criteria approach to priority setting is necessary, and this has indeed recently been identified as one of the most important issues in health system research. In other scientific disciplines, multi-criteria decision analysis is well developed, has gained widespread acceptance and is routinely used. This paper presents the main principles of multi-criteria decision analysis. There are only a very few applications to guide resource allocation decisions in health. We call for a shift away from present priority setting tools in health--that tend to focus on single criteria--towards transparent and systematic approaches that take into account all relevant criteria simultaneously.

译文

卫生干预措施的优先级设定通常是临时性的,资源的使用没有达到最佳程度。潜在的问题是,多个标准发挥作用,决策很复杂。可以选择干预措施,以最大程度地提高总体人口健康水平,减少弱势或弱势群体的健康不平等,ad/或应对威胁生命的情况,所有这些都涉及实际和预算方面的限制。这是政策制定者通常不善于理性地、没有帮助地解决的问题。他们倾向于使用启发式或直观的方法来简化复杂性,在此过程中,重要的信息被忽略。接下来,政策制定者可能只出于政治动机选择干预措施。这表明需要合理和透明的方法来确定优先级。在过去的几十年中,已经开发了许多方法,包括循证医学,疾病负担分析,成本效益分析和公平性分析。但是,这些方法仅集中在单个标准上,而实际上,决策者需要同时考虑多个标准来做出选择。此外,它们并未涵盖与决策者相关的所有标准。因此,有必要开发一种多标准方法来确定优先级,并且最近确实已将其确定为卫生系统研究中最重要的问题之一。在其他科学学科中,多准则决策分析得到了很好的发展,得到了广泛的认可,并被常规使用。本文介绍了多准则决策分析的主要原理。只有很少的应用程序来指导健康中的资源分配决策。我们呼吁从目前的卫生优先事项设定工具 (往往侧重于单一标准) 转向透明和系统的方法,同时考虑到所有相关标准。

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