شناسایی معیارها، رویکردها و مدل‌های اولویت‌بندی مداخلات بهداشتی برای طراحی بسته مزایای پایه سلامت: یک مرور حیطه ای

نوع مقاله : مرور دامنه ای

نویسندگان
شیوا اونق 1
شقایق وحدت 1
شهرام توفیقی 2
سمیه حسام 1
1 گروه مدیریت خدمات بهداشتی درمانی، واحد تهران جنوب، دانشگاه آزاد اسلامی، تهران، ایران
2 گروه آینده نگری، نظریه‌پردازی و رصدخانه سلامت، آکادمی پزشکی جمهوری اسلامی ایران، تهران، ایران
10.48305/him.2025.45682.1337
چکیده
اهداف: هدف مطالعه، شناسایی معیارها، رویکردها و مدل‌های موثر برای اولویت‌بندی مداخلات سلامت درکشورهای مختلف، به‌منظور طراحی بسته مزایای پایه سلامت (BHBP) بود.

مواد و روش‌ها: مرور حیطه‌ای بر اساس چک‌لیست راهنمایPRISMA -ScR انجام شد. جست‌وجوهای الکترونیکی در PubMed، Cochrane Library، و برای پوشش گسترده‌تر از GoogleScholar، ScienceDirect(Elsevier)،SpringerLink و منابع فارسی (MagIran, SID) از ژانویه ۲۰۰۵ تا ژوئن ۲۰۲۴ صورت گرفت و با جستجوی دستی در منابعWHO، بانک جهانی، گوگل و ارجاعات مقالات تکمیل شد. از ۲۲۶۶ مطالعه، ۴۲ مطالعه برای تحلیل نهایی انتخاب شدند و مدیریت منابع با EndNote انجام گرفت.

نتایج: معیارها شامل، اقتصادی، اثربخشی، برابری-اجتماعی و فرعی بودند. معیارهای اقتصادی (هزینه‌اثربخشی) و اثربخشی (بار بیماری) در اکثر کشورها رایج‌اند، اما درکشورهای درآمد بالا، معیارهای برابری-اجتماعی اولویت دارند. رویکردهای ارزیابی فناوری سلامت (HTA)و فرآیندهای مشورتی مبتنی بر شواهد (EDPs)درکشورهای درآمد بالا رایج‌اند، وکشورهای کم‌درآمد به مشارکت ذی‌نفعان و مدل‌های جهانی مانند (اولویت‌های کنترل بیماری- پوشش بهداشتی ضروری همگانی (DCP3-EUHC)، بارجهانی بیماری و مداخلات مقرون‌به‌صرفه سازمان جهانی بهداشت (WHO-CHOICE)) یا ترکیبی از آن‌ها تکیه دارند.

نتیجه‌گیری: معیارهای اقتصادی و اثربخشی در اولویت‌بندی مداخلاتBHBP رایج هستند، اما با افزایش درآمد، برابری/عدالت و معیارهای فرعی اهمیت می‌یابند. رویکردهای HTA درکشورهای درآمد بالا و مدل‌هایDCP3 در کم‌درآمد رایج‌اند. این یافته‌ها با اهداف توسعه پایدار همسو می‌باشد.

پیام کلیدی: سیاست‌گذاران درکشورهای کم‌درآمد، HTA را با مدل‌هایDCP3 با تمرکز بر مشارکت ذی‌نفعان و برابری برای بهینه‌سازی منابع ادغام کنند تا تعادل بین اقتصاد و برابری/عدالت برقرار شود و نابرابری‌های دسترسی کاهش یابد.

کلیدواژه‌ها

موضوعات

عنوان مقاله English

Identification of Criteria, Approaches, and Models for Prioritizing Health Interventions to Design the Basic Health Benefit Package (BHBP): A Scoping Review

نویسندگان English

Shiva Onegh 1
Shaghayegh vahdat 1
Shahram Tofighi 2
Somayeh Hessam 1
1 Department of Health Service Administration, ST.C., Islamic Azad University, Tehran, Iran.
2 Department of Forecasting, Theory Building and Health Observatory, Medical Academy of IRI, Tehran, Iran
چکیده English

Objectives: The aim of this study was to identify effective criteria, approaches, and models for prioritizing health interventions across various countries to inform the design of the Basic Health Benefits Package (BHBP).

Materials and Methods: The scoping review was conducted based on the PRISMA-ScR checklist. Electronic searches were performed in PubMed, Cochrane Library, and—for broader coverage—Google Scholar, ScienceDirect (Elsevier), SpringerLink, and Persian databases (MagIran, SID) from January 2005 to June 2024. These were supplemented by manual searches in WHO and World Bank resources, Google, and article references. Of 2,266 studies identified, 42 were selected for final analysis, with reference management handled using EndNote.

Results: Criteria were categorized as economic, effectiveness-related, equity-social, and subsidiary. Economic criteria (cost-effectiveness) and effectiveness (disease burden) were prevalent in most countries; however, equity-social criteria predominated in high-income countries. Health Technology Assessment (HTA) approaches and evidence-based deliberative processes (EDPs) were common in high-income countries, whereas low-income countries relied on stakeholder engagement and global models such as Disease Control Priorities (DCP3), Essential Universal Health Coverage (EUHC), Global Burden of Disease, and WHO-CHOICE cost-effective interventions—or combinations thereof.

Conclusions: Economic and effectiveness criteria are commonly used in prioritizing BHBP interventions, but equity/justice and subsidiary criteria gain prominence with increasing income levels. HTA approaches prevail in high-income countries, while DCP3 models are more common in low-income settings. These findings align with the Sustainable Development Goals.

Key Message: Policymakers in low-income countries should integrate HTA with DCP3 models, emphasizing stakeholder engagement and equity, to optimize resource allocation, balance economic and equity/justice considerations, and reduce access inequalities.

کلیدواژه‌ها English

Essential Health Benefit Package
Health Benefit Package
Basic Health Insurance Package
Healthcare Prioritization
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