Priority Setting, Information Value and Performance Incentives in Healthcare

  • Autor: Jorge Luis Gómez Torres
  • Director/es: Jorge E. Martínez Pérez, José Mª Abellán Perpiñán
  • Defensa: 12/12/2024 - Universidad de Murcia
  • Tribunal: Vicente Ortún Rubio, Máximo C. Camacho Alonso, Isabel Pardo García
  • Calificación: Sobresaliente cum laude
  • Ver publicaciones relacionadas

Esta tesis doctoral aborda tres problemas fundamentales en el ámbito de la economía de la salud, ofreciendo soluciones prácticas a través de un enfoque metodológico riguroso. En un contexto de creciente complejidad en la atención sanitaria, tanto por el envejecimiento de la población como por la mayor demanda de servicios de calidad, se hace necesario desarrollar herramientas que permitan mejorar la toma de decisiones y la asignación de recursos. A través de la presente investigación, se busca no solo aportar al conocimiento científico, sino también ofrecer soluciones que puedan implementarse, optimizando la prestación de servicios y los resultados en salud.
El primer problema abordado en la tesis está relacionado con la adopción de tecnologías sanitarias en el Servicio Murciano de Salud. En este estudio, se desarrolló un marco de análisis de decisión multicriterio (MCDA) para facilitar la priorización de tecnologías de alto impacto. La creciente demanda de nuevas tecnologías exige métodos más estructurados y transparentes que permitan equilibrar los beneficios clínicos, los costos económicos y las implicaciones sociales y organizativas. Para ello, se adaptaron marcos previos de MCDA, como el modelo EVIDEM, a las particularidades del sistema sanitario español. Tras una revisión exhaustiva de la literatura y la validación de criterios a través de consultas con profesionales sanitarios, se establecieron los dominios de análisis, que incluyen la necesidad, los resultados esperados y el grado de conocimiento de la intervención, su impacto económico y su viabilidad. Los resultados muestran que, aunque tanto los profesionales sanitarios como el público general priorizan los resultados clínicos, los profesionales otorgan mayor relevancia al impacto económico, subrayando la importancia de diseñar modelos que equilibren la eficacia clínica con las restricciones presupuestarias.
El segundo problema estudiado trata sobre la valoración económica de la información contenida en los prospectos de medicamentos. Tradicionalmente, se ha considerado que el valor de las intervenciones sanitarias depende solo de los resultados en salud. Sin embargo, este trabajo parte de la premisa de que la información sobre riesgos y beneficios también tiene un valor intrínseco para los pacientes. A través de la metodología de valoración contingente, se diseñaron encuestas para estimar la disposición a pagar (DAP) por recibir información más detallada sobre los medicamentos, comparando un prospecto tradicional con un folleto adicional que incluía datos cuantitativos sobre los beneficios y efectos adversos. La muestra fue dividida en dos grupos para evaluar la valoración de ambos formatos. Los resultados muestran que la DAP fue mayor cuando la información se presentaba de manera cuantitativa y clara, utilizando ayudas visuales y frecuencias naturales. Además, se observó una relación positiva entre la DAP y variables como la edad y el nivel de ingresos, lo que valida teóricamente los resultados obtenidos.
Finalmente, el tercer problema abordado en esta tesis consiste en una revisión sistemática sobre los esquemas de pago por desempeño (P4P) en la atención primaria de salud. El objetivo de este estudio fue identificar las mejores prácticas internacionales y proponer un modelo de incentivos para el sistema de salud español. Siguiendo los criterios PRISMA, se realizó una revisión exhaustiva de la literatura en bases de datos como Medline, Scopus y PubMed, analizando el impacto de los esquemas P4P en los resultados de salud. Los resultados son variados y dependen en gran medida del contexto en el que se implementan los incentivos. Si bien algunos estudios muestran mejoras en la gestión de enfermedades crónicas, otros no encuentran una relación directa entre los incentivos económicos y los resultados de salud a largo plazo. Esto sugiere que los esquemas P4P deben acompañarse de mecanismos de apoyo organizativo, formación continua y retroalimentación para ser efectivos.

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By surveying a sample of the general population, we obtain willingness-to-pay estimates of the value of providing additional quantitative information on potential benefits and side effects of a hypothetical medicine, according to the best evidence available about risk communication. The willingness-to-pay estimates found in our study ranged from 60 cents to 1 euro per month. In addition, some consistency tests of the robustness of our estimates are also presented, as well as evidence on their feasibility, reliability and validity. [post_title] => The Intrinsic Value of the Information Contained in Medicine Leaflets [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => the-intrinsic-value-of-the-information-contained-in-medicine-leaflets [to_ping] => [pinged] => [post_modified] => 2024-12-23 13:15:06 [post_modified_gmt] => 2024-12-23 12:15:06 [post_content_filtered] => [post_parent] => 0 [guid] => http://doctoradodecide.com/?post_type=publicaciones&p=4020 [menu_order] => 0 [post_type] => publicaciones [post_mime_type] => [comment_count] => 0 [filter] => raw ) [1] => WP_Post Object ( [ID] => 4018 [post_author] => 19 [post_date] => 2024-11-19 13:12:17 [post_date_gmt] => 2024-11-19 12:12:17 [post_content] => Abstract Objectives: This study aims to develop a framework for establishing priorities in the regional health service of Murcia, Spain, to facilitate the creation of a comprehensive multiple criteria decision analysis (MCDA) framework. This framework will aid in decision-making processes related to the assessment, reimbursement, and utilization of high-impact health technologies. Method: Based on the results of a review of existing frameworks for MCDA of health technologies, a set of criteria was proposed to be used in the context of evaluating high-impact health technologies. Key stakeholders within regional healthcare services, including clinical leaders and management personnel, participated in a focus group (n = 11) to discuss the proposed criteria and select the final fifteen. To elicit the weights of the criteria, two surveys were administered, one to a small sample of healthcare professionals (n = 35) and another to a larger representative sample of the general population (n = 494). Results: The responses obtained from health professionals in the weighting procedure exhibited greater consistency compared to those provided by the general public. The criteria more highly weighted were “Need for intervention” and “Intervention outcomes.” The weights finally assigned to each item in the multicriteria framework were derived as the equal-weighted sum of the mean weights from the two samples. Conclusions: A multi-attribute function capable of generating a composite measure (multicriteria) to assess the value of high-impact health interventions has been developed. Furthermore, it is recommended to pilot this procedure in a specific decision context to evaluate the efficacy, feasibility, usefulness, and reliability of the proposed tool. 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By surveying a sample of the general population, we obtain willingness-to-pay estimates of the value of providing additional quantitative information on potential benefits and side effects of a hypothetical medicine, according to the best evidence available about risk communication. The willingness-to-pay estimates found in our study ranged from 60 cents to 1 euro per month. In addition, some consistency tests of the robustness of our estimates are also presented, as well as evidence on their feasibility, reliability and validity. 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