본문 바로가기
KERD
논문KCI 등재

보건의료자원 배분의 우선순위 설정 기준에 대한 체계적 문헌고찰

A systematic review of priority setting in healthcare resource allocation

임민경|배은영|배그린|이보람
한국보건경제정책학회 (The Korean Association of Health Economics and Policy)|2019.12|보건경제와 정책연구 (The Korean Journal of Health Economics and Policy)|제25권 제4호|pp. 57-91

0

조회

0

다운로드

3

인용

0

참고문헌

키워드

체계적 문헌고찰우선순위systematic review의사결정decision makingresource allocation자원배분priority setting
주제분류사회과학일반

초록

희소한 자원으로 인한 우선순위 결정의 문제는 효율성과 형평성으로 대표되는 여러 가지 기준에 대한 논의를 필요로 한다. 그러나 우리 사회에서 보건의료분야의 의사결정에 고려해야 할 사회적 가치에 대한 연구는 여전히 부족한 실정이다. 본 연구는 국내 및 국외 학술 데이터베이스를 대상으로 보건의료분야에서 자원 배분에 대한 우선순위 설정 기준을 다룬 선행 연구에 대한 체계적 문헌고찰을 수행하였다. 검색된 4,386개 문헌을 대상으로 선택 및 배제 과정을 거쳐 70개 연구를 최종적으로 선정하였다. 2010년 이후에 수행된 연구가 가장 많았으며 주로 영국을 비롯한 유럽 국가에서 활발한 연구가 진행되었고 우리나라에서 수행된 연구는 10건이었다. 가장 많이 논의된 우선순위 기준은 질병의 위중도와 중재로 인한 건강 결과였다. 질병의 위중도가 심각할수록, 중재를 통해 얻을 수 있는 건강 결과가 클수록 높은 선호를 보였다. 개별 연구 간 사회적, 정치적, 문화적, 제도적 차이가 있음에도 불구하고 보편적으로 중요한 것으로 여겨지는 가치는 있는 것으로 확인되었으나 여러 연구 결과를 직접적으로 비교하는 것은 어려웠다. 본 연구 결과를 바탕으로 향후 우리 사회 구성원의 다양한 목소리를 반영한 우선순위 설정에 대한 연구가 활발해지기를 기대한다.

Abstract

Decision making in healthcare due to resource scarcity requires consideration for vaious criteria of priority setting like efficiency and equity. However, in Korea, there were not sufficient researches on the social values considered in allocation of healthcare resource. This study carried out a systematic review of priority setting in healthcare resource allocation. Ovid Medline, Embase, Econlit, Web of Science, RISS, and KISS were searched for English or Korean language publications. Initially, 4,386 articles were identified and 70 studies were finally selected. Most of the studies conducted after 2010. European countries including the UK did the most studies and 10 were conducted in Korea. The most frequently discussed criteria were severity of illness and health outcome of intervention. Patient with more severe disease and interventions having much greater health outcome were more preferred. Despite of social, political, cultural and methodological differences between the individual studies, it found that the common social value existed. But it was still difficult to compare criteria and their weights directly. Future studies on priority setting in healthcare will be need with more precise and sophisticated framework to reflect social value of stakeholders in Korea.

참고문헌 (89)

  1. 건강보험심사평가원, "약제의 요양급여대상여부 등의 평가기준 및 절차 등에 관한 규정", 건강보험심사평가원, ~ (2018)
  2. 보장성 강화를 위한 예방의료서비스의 우선순위 개발, "고민정", 한국보건의료연구원, ~ (2014)
  3. 권순만, "보건의료 정책 의사결정과 시민참여 :『건강보험 보장성 시민위원회』의 사례", 보건행정학회지, 22(4), pp.467~496 (2012), 한국보건행정학회
  4. 적정 의료자원할당을 위한 사회적 합의모델에 관한 연구, "이상이", 국민건강보험공단, ~ (2005)
  5. 사회적 합의에 기반한 의료자원 우선순위에 관한 연구, "이상이", 국민건강보험공단, ~ (2006)
  6. 임민경, "선택실험법을 이용한 의약품 급여결정기준에 대한 선호분석", 보건행정학회지, 19(4), pp.98~120 (2009), 한국보건행정학회
  7. 정형선, "건강보험 기본급여의 우선순위", 보건행정학회지, 14(2), pp.34~57 (2004), 한국보건행정학회
  8. 정형선, "Analytic Hierarchy Process를 이용한 건강보험 급여 우선순위 결정: 4대 중증질환 비급여항목을 중심으로", 보건행정학회지, 24(2), pp.181~190 (2014), 한국보건행정학회[DOI]
  9. 조창익, "Using Discrete Choice Experiments to Estimate the Marginal Willingness to Pay of Insurance Premium for the Cancer Treatments in Korea: A General Population Study", 보건사회연구, 33(2), pp.578~602 (2013), 한국보건사회연구원[DOI]
  10. 최숙자, "계층적분석법(AHP)을 이용한 건강보험급여확대상병 우선순위 결정", 보건행정학회지, 16(1), pp.73~94 (2006), 한국보건행정학회
  11. Arora, C., "The Intensive Care Lifeboat: a survey of lay attitudes to rationing dilemmas in neonatal intensive ca", BMC medical ethics, 17(1), pp.69~ (2016)
  12. Baji, P., "Comparative analysis of decision maker preferences for equity", efficiency attributes in reimbursement decisions in three European countries, 2016, pp.17(7), 791~799
  13. Baltussen, R., "Priority setting of health interventions: the need for multi-criteria decision analysis", Cost effectiveness and resource allocation, 4(1), pp.14~ (2006)
  14. Baltussen, R., "Towards a multi-criteria approach for priority setting: an application to Ghana", Health economics, 15(7), pp.689~696 (2006)
  15. Baron, J., "Revising a priority list based on cost-effectiveness: The role of the prominence effect and distorted utility judgments", Medical Decision Making, 21(4), pp.278~287 (2001)
  16. Bowling, A., "Health care rationing: the public's debate", BMJ, 312(7032), pp.670~674 (1996)
  17. Browning, C.J., "Community values and preferences in transplantation organ allocation decisions", Social science & medicine, 52(6), pp.853~861 (2001)
  18. Desser(a), A.S., "Prioritizing treatment of rare diseases: a survey of preferences of Norwegian doctors", Social science & medicine, 94, pp.56~62 (2013)
  19. Desser(b), A. S., "Societal views on orphan drugs : cross sectional survey of Norwegians aged 40 to 67", BMJ, 341, pp.c4715~ (2010)
  20. Desser, A. S., "Eliciting preferences for prioritizing treatment of rare diseases : the role of opportunity costs and framing effects", Pharmacoeconomics, 31(11), pp.1051~1061 (2013)
  21. Diederich, A., "Citizen participation in patient prioritization policy decisions : an empirical and experimental study on patients' characteristics", PLoS One, 7(5), pp.e36824~ (2012)
  22. Diederich, A., "Age as a criterion for setting priorities in health care? A survey of the German public view", PLoS One, 6(8), pp.e23930~ (2011)
  23. Dolan, P., "A note on the relative importance that people attach to different factors when setting priorities in health care", Health expectations, 6(1), pp.53~59 (2003)
  24. Dolan, P., "QALY maximisation and people's preferences: a methodological review of the literature", Health economics, 14(2), pp.197~208 (2005)
  25. Dolan, J.G., "Multi-criteria clinical decision support", Patient, 3(4), pp.229~248 (2010)
  26. Edwards, R.T., "Clinical and lay preferences for the explicit prioritisation of elective waiting lists: survey evidence from Wales", Health Policy, 63(3), pp.229~237 (2003)
  27. Erdem, S., "Prioritising health service innovation investments using public preferences: a discrete choice experiment", BMC health services research, 14(1), pp.360~ (2014)
  28. Fortes, P.A., "A study on the ethics of microallocation of scarce resources in health care", Journal of medical ethics, 28(4), pp.266~269 (2002)
  29. Gill, R.S., "Prioritization and willingness to pay for bariatric surgery: the patient perspective", Canadian Journal of Surgery, 57(1), pp.33~39 (2014)
  30. Golan, O., "Health technology prioritization: which criteria for prioritizing new technologies and what are their relative weights?", Health policy, 102(2-3), pp.126~135 (2011)
  31. Green(a), C., "Investigating public preferences on ‘severity of health’as a relevant condition for setting healthcare priorities", Social Science & Medicine, 68(12), pp.2247~2255 (2009)
  32. Green(b), C., "Exploring the social value of health-care interventions: a stated preference discrete choice experiment", Health economics, 18(8), pp.951~976 (2009)
  33. Gu, Y., "Attributes and weights in health care priority setting: a systematic review of what counts and to what extent", Social Science & Medicine, 146, pp.41~52 (2015)
  34. Gulacsi, L., "Prioritization preferences among general practitioners in Hungary", East European Politics and Societies, 26(1), pp.20~32 (2012)
  35. Gurtner, S., "Making the right decisions about new technologies: a perspective on criteria and preferences in hospitals", Health care management review, 39(3), pp.245~254 (2014)
  36. Higginson, I.J., "Priorities for treatment, care and information if faced with serious illness: a comparative population-based survey in seven European countries", Palliative medicine, 28(2), pp.101~110 (2014)
  37. Holloway, R. G., "US neurologists : attitudes on rationing", Neurology, 55(10), pp.1492~1497 (2000)
  38. Jehu-Appiah, C., "Balancing equity and efficiency in health priorities in Ghana : the use of multicriteria decision analysis", Value in Health, 11(7), pp.1081~1087 (2008)
  39. Johnson, F.R., "Eliciting Stated Preferences for Health-Technology Adoption Criteria Using Paired Comparisons and Recommendation Judgments", Value in health, 9(5), pp.303~311 (2006)
  40. Johri, M., "The importance of age in allocating health care resources: does intervention-type matter?", Health economics, 14(7), pp.669~678 (2005)
  41. Kapiriri, L., "Criteria for priority-setting in health care in Uganda:exploration of stakeholders' values", Bulletin of the World Health Organization, 82, pp.172~179 (2004)
  42. Kasemsup, V., "Citizen's Preferences Regarding Principles to Guide Health-Care Allocation Decisions in Thailand", Value in Health, 11(7), pp.1194~1202 (2008)
  43. Kolasa, K., "Does it matter whose opinion we seek regarding the allocation of healthcare resources? a case study", BMC health services research, 15(1), pp.564~ (2015)
  44. Krutli, P., "How to fairly allocate scarce medical resources : Ethical argumentation under scrutiny by health professionals and lay people", PloS One, 11(7), pp.e0159086~ (2016)
  45. Kwon, S.H., "Eliciting societal preferences of reimbursement decision criteria for anti cancer drugs in South Korea", Expert review of pharmacoeconomics & outcomes research, 17(4), pp.411~419 (2017)
  46. Lane, H., "Equity in healthcare resource allocation decision making: a systematic review", Social Science & Medicine, 175, pp.11~27 (2017)
  47. Lim, M.K, "Eliciting public preference for health-care resource allocation in South Korea", Value in Health, 15(1), pp.S91~S94 (2012)
  48. Linley(a), W.G., "Decision-makers’ preferences for approving new medicines in wales: a discrete-choice experiment with assessment of external validity", Pharmacoeconomics, 31(4), pp.345~355 (2013)
  49. Linley(b), W.G., "Societal views on NICE, cancer drugs fund and value?based pricing criteria for prioritising medicines: A cross-sectional survey of 4118 adults in Great Britain", Health economics, 22(8), pp.948~964 (2013)
  50. Mack, P., "Utilitarian ethics in healthcar", International Journal of the Computer, the Internet and Management, 12(3), pp.63~72 (2004)
  51. McHugh, N., "Extending life for people with a terminal illness: a moral right and an expensive death? Exploring societal perspectives", BMC medical ethics, 16(1), pp.14~ (2015)
  52. McKie, J., "Social preferences for prioritizing the treatment of severely ill patients: the relevance of severity, expected benefit, past health and lifetime health", Health Policy, 121(8), pp.913~922 (2017)
  53. Mentzakis, E., "A discrete choice experiment investigating preferences for funding drugs used to treat orphan diseases: an exploratory study", Health Economics, Policy and Law, 6(3), pp.405~433 (2011)
  54. Mentzakis, E., "Priority setting in the Austrian healthcare system: results from a discrete choice experiment and implications for mental health", The journal of mental health policy and economics, 17(2), pp.61~73 (2014)
  55. Mortimer, D., "Is the value of a life or life-year saved context specific? Further evidence from a discrete choice experiment", Cost Effectiveness and Resource Allocation, 6(1), pp.8~ (2008)
  56. National Institute for Health and Clinical Excellence (NICE), "Social Value Judgements:Principles for the develoment of NICE guidance", ~ (2008)
  57. Nord, E., "The relevance of health state after treatment in prioritising between different patients", Journal of medical Ethics, 19(1), pp.37~42 (1993)
  58. Nord, E., "Maximizing health benefits vs egalitarianism: an Australian survey of health issues", Social science & medicine, 41(10), pp.1429~1437 (1995)
  59. Oh, J., "Participation of the lay public in decision-making for benefit coverage of national health insurance in South Korea", Health Systems & Reform, 1(1), pp.62~71 (2015)
  60. Olsen, J.A., "Preferences for the normative basis of health care priority setting: some evidence from two countries", Health economics, 22(4), pp.480~485 (2013)
  61. Ottersen, T., "Distribution matters: equity considerations among health planners in Tanzania", Health Policy, 85(2), pp.218~227 (2008)
  62. Perneger, T.V., "Physicians’ attitudes toward health care rationing", Medical decision making, 22(1), pp.65~70 (2002)
  63. Rodríguez-Míguez, E., "Measuring the social importance of concentration or dispersion of individual health benefits", Health Economics, 11(1), pp.43~53 (2002)
  64. Ryynanen, O. P., "Random paired scenarios - a method for investigating attitudes to prioritisation in medicine", Journal of medical ethics, 22(4), pp.238~242 (1996)
  65. Sampietro-Colom, L., "Wide social participation in prioritizing patients on waiting lists for joint replacement: a conjoint analysis", Medical Decision Making, 28(4), pp.554~566 (2008)
  66. Schwappach, D.L., "Does it matter who you are or what you gain? An experimental study of preferences for resource allocation", Health economics, 12(4), pp.255~267 (2003)
  67. Shiroiwa, T., "Societal preferences for interventions with the same efficiency: assessment and application to decision making", Applied health economics and health policy, 14(3), pp.375~385 (2016)
  68. Skedgel, C. D., "Choosing vs. allocating: discrete choice experiments and constant-sum paired comparisons for the elicitation of societal preferences", Health Expectations, 18(5), pp.1227~1240 (2013)
  69. Skedgel, C., "Societal preferences for distributive justice in the allocation of health care resources: a latent class discrete choice experiment", Medical Decision Making, 35(1), pp.94~105 (2015)
  70. Skedgel, C., "The prioritization preferences of pan-Canadian Oncology Drug Review members and the Canadian public: a stated-preferences comparison", Current Oncology, 23(5), pp.322~328 (2016)
  71. Society of Critical Care Medicine Ethics Committee, "Attitudes of critical care medicine professionals concerning distribution of intensive care resources", Critical Care Medicine, 22(2), pp.358~362 (1994)
  72. Stolk, E.A., "Equity in health care prioritisation: an empirical inquiry into social value", Health Policy, 74(3), pp.343~355 (2005)
  73. Tanios, N., "Which criteria are considered in healthcare decisions? Insights from an international survey of policy and clinical decision makers", International journal of technology assessment in health care, 29(4), pp.456~465 (2013)
  74. Theodorou, M., "The Public’s and Doctors’ Perceived Role in Participation in Setting Health Care Priorities in Greece", Hellenic Journal of Cardiology, 51, pp.200~208 (2010)
  75. Thokala, P., "Multiple criteria decision analysis for health technology assessment", Value in Health, 15(8), pp.1172~1181 (2012)
  76. Ubel(a), P.A., "Public perceptions of the importance of prognosis in allocating transplantable livers to children", Medical Decision Making, 16(3), pp.234~241 (1996)
  77. Ubel(b), P. A., "Distributing scarce livers : the moral reasoning of the general public", Social science & medicine, 42(7), pp.1049~1055 (1996)
  78. Ubel(a), P.A., "How stable are people’s preferences for giving priority to severely ill patients?", Social science & medicine, 49(7), pp.895~903 (1999)
  79. Ubel(b), P.A., "Life-saving treatments and disabilities: Are all QALYs created equal?", International journal of technology assessment in health care, 15(4), pp.738~748 (1999)
  80. Ubel, P.A., "Are preferences for equity over efficiency in health care allocation "all or nothing"?", Medical care, 38(4), pp.366~373 (2000)
  81. Ubel, P.A., "Allocation of transplantable organs: do people want to punish patients for causing their illness?", Liver Transplantation, 7(7), pp.600~607 (2001)
  82. Van de Wetering, E.J., "Are some QALYs more equal than others?", The European Journal of Health Economics, 17(2), pp.117~127 (2016)
  83. Wagner, M., "Appraising the holistic value of Lenvatinib for radio-iodine refractory differentiated thyroid cancer: A multi-country study applying pragmatic MCDA", BMC cancer, 17(1), pp.272~ (2017)
  84. Wahlster, P., "Exploring the perspectives and preferences for HTA across German healthcare stakeholders using a multi-criteria assessment of a pulmonary heart sensor as a case study", Health research policy and systems, 13(1), pp.24~ (2015)
  85. Werner, P., "Israeli lay persons’ views on priority-setting criteria for Alzheimer’s disease", Health Expectations, 12(2), pp.187~196 (2009)
  86. Whitty, J.A, "A systematic review of stated preference studies reporting public preferences for healthcare priority setting", Patient, 7(4), pp.365~386 (2014)
  87. Williams, A., "Intergenerational equity: an exploration of the ‘fair innings’ argument", Health economics, 6(2), pp.117~132 (1997)
  88. Wouters, S., "Priority to end of life treatments? Views of the public in the Netherlands", Value in Health, 20(1), pp.107~117 (2017)
  89. Youngkong, S., "Criteria for priority setting of HIV", AIDS interventions in Thailand: a discrete choice experiment, 2010, pp.10(1), 197~

관련 논문AI추천

보건분야 우선순위 설정에 대한 외국 사례 비교 및 정책적 시사점강민선, 송현종, 오주연, 정설희, 조수진한국보건경제정책학회 · 보건경제와 정책연구2008 · 제14권 제1호포커스 그룹인터뷰를 통한 보건의료자원배분 우선순위에 대한 사회적 선호 확인: 연령, 중증도, 사회적 연대를 중심으로배그린, 배은영, 이보람, 임민경한국보건경제정책학회 · 보건경제와 정책연구2022 · 제28권 제1호누구의 필요(Need)를 더 우선적으로 고려할 것인가?배은영한국보건의료기술평가학회 · 보건의료기술평가2016 · 제4권 제1호중증질환 치료제에 대한 급여정책을 둘러싼 윤리적 쟁점 고찰배승진, 배은영, 임민경한국보건경제정책학회 · 보건경제와 정책연구2015 · 제21권 제1호보건의료의사결정에 다기준결정분석(Multi-criteria decision analysis)의 활용가능성에 대한 탐색배은영, 이지연, 이혜재한국보건경제정책학회 · 보건경제와 정책연구2014 · 제20권 제3호보건의료 자원할당의 우선순위 선정에서 사회적 합의 모델에 관한 연구문성웅, 서남규, 이용갑한국사회정책학회 · 한국사회정책2009 · 제16권 제1호

이 간행물의 다른 논문 (3건)

공공 및 민간 의료기관에 대한 공급자 유인 수요 및 의료비 분석사공진, 정수진pp. 1-28재난적의료비, 의료비만의 문제인가 -중장기 입원으로 인한 근로소득 감소의 매개효과를 중심으로-정현우, 차선화, 이준협, 양정연pp. 29-56보장성 강화 정책에 따른 병원급 의료기관의 병상 규모별 진료비 구성의 변화서남규, 이옥희, 안수지pp. 93-118
원문 보기