使用数学建模确定健康优先级的经验教训

Authors David Wilson, Health Nutrition and Population Global Practice, World Bank, Washington DC,USA Marelize Gorgens, Health Nutrition andPopulation Global Practice, World Bank, WashingtonDC, USA Corresponding author:Marelize Gorgens,mgorgens@worldbank.org, The World Bank, 1818 H Street NW, Washington DC, 20433, +1 202 473 1000 Keywords:priority setting; benefits packages; health financing; World Bank Disclosure of Interest The authors report no conflict of interest. Abstract: The COVID-19 pandemic hashighlightedthe need for priority setting in health financing andresource allocation, spotlighting the limitations of traditional health financing strategies. Thiscommentaryexplores the relevance of mathematical modeling in enhancing allocative efficiencywithin the health sector, especially in the aftermath of the pandemic.Wedraw from the WorldBank’s experiences in supporting over 20 countries to employ mathematical optimization modelsfor priority setting, aiming to achieve optimal health outcomes within constrained budgets.Thepandemic's impact on economic growth, revenue collection, debt stress, and the overall fiscalspace available for health financing has necessitated a paradigm shift towards prioritizingefficiency improvements in health service delivery. Weoutlinelessons learned from suchmodeling and chartfuture directions to enhance efficiency gains, including forintegrated,patient-centered approaches to health service delivery.Weadvocate forflexible and effectivelocalized priority-setting, leveraging data-driven insights to navigate the complexities of healthfinancing in a post-COVID era. Lessons Learned in Using Mathematical Modelling for Priority Setting in Health Conventional approaches to health financing focus on five dimensions: First, increase economicgrowth, so there is a larger pie to share. Second, improve revenue collection sogovernments cancapture a larger share of the economy for public expenditure. Third,strive to mitigate debt stressso countries have more resources to allocate to health and the social sectors. Fourth,improveallocative efficiency in the health sector through better prioritization,allowingMinistries ofHealthandtheirdevelopment partnerstodirect funding to areas where it can have the greatestimpact on population health outcomes. Fifth,enhancetechnical and production efficiencytoallowMinistries of Healthtodeliverhealthservices usingmodalitiesand mechanismsthatensure cost-effective delivery.1 COVID-19 has profoundly and differentially affected health financing In thiscommentary,we focusnot only onthe lessons of COVID, butalsothe lessons about usingmodeling for prioritization. COVID has made lessonsaboutprioritization more urgent than everbecause of its impact on economies, budgets and health financing, health system performance,and theworkforce. The COVID-19 pandemic has profoundly affectedfivedimensions: (a) Economic growth isstunted, especially in low-income countries that need funding the most, putting extraordinarystrain on health budgets and fiscal space available for allocation to the health sector. Kose etal.showed that manycountries, especiallylower-middle-income countries,willhavesmallereconomiesby 2025 than they would havehadwithout COVID-19.2(b) In terms of revenuecollection, even prior to COVID-19,manycountriesespeciallylow-and middle-income countriesraised less revenue as a share of gross domestic product(GDP)(Figure 1).3Lowerrevenue collection as a share of GDP in low-and middle-income countries(LMICs)isoften dueto high levels of informal economic activity.In these settings, themost efficient revenuecollectionmethods, such astaxes on the consumption of cellular or internet services, or mobilemoney,maydisproportionately affect low-income groups.4COVID-19 exacerbated theinformality, resulting in proportionately reduced revenue collection. (c) COVID-19 has amplifiedthe need to use every health dollar well: allocative, production,and technical efficiency arearguablymuch more critical than in the past.In the aftermath of COVID-19, both developmentassistance and national domestic budgets, especially for health, are more limited and debated.This situation indicates that itis crucial forMinistries of Health to prioritize efficiencyimprovements.5 Source: IMF, 2023. https://www.imf.org/external/datamapper/rev@FPP/USA/FRA/JPN/GBR/SWE/ESP/ITA/ZAF/I Governmentsare facing increasing pressureas their health resources, already limited, continue todiminish in some cases.. They must simultaneouslyre-build essential services,enhancebothessential and public health services, preparefor future health emergencies regardless of etiology,address the risingdisease burden,meet the demands forperson-centered healthcareand budgetfor an expanding range of new health products, from innovations in vaccines to cancertreatments. Thiscomprehensive and expanding agendawillonlyintensifywith the additionalchallengesposed byclimate change. To address this agenda, a multi-pronged appro