Cost‐effectiveness analysis and health care resource allocation: decision rules under variable returns to scale
指出卫生服务常违背恒定规模收益假设，识别三种规模收益类型，证明传统决策规则非最优，推导可变规模收益下的最优决策规则并用实例说明。
We argue that health programs are administered in settings that often violate the frequently stated assumption of constant returns to scale in the provision of health services. Three types of returns to scale are identified from the general economic literature: returns to scale with respect to population, effectiveness, and quality. We show that decision rules based on incremental cost-effectiveness ratios or cost-benefit tests are not optimal if returns to scale are not constant. We derive the optimal decision rules under variable returns to scale using optimization techniques, and employ several examples to illustrate the concepts and methods.