Criteria and procedures for determining benefit packages in health care. A comparative perspective.
The legitimacy of procedures and criteria for determining benefit packages depends crucially on the representation of stakeholders in decision-making bodies, the transparency of procedures and the consistency of benefit decisions. Moreover, the assessment of the costs of healthcare services and its application as a decision criterion can be an important policy instrument in order to increase the overall efficiency of healthcare systems. Our analysis of procedures and criteria for determining benefit packages in England, Germany and Switzerland established potential for developing more legitimate procedures and criteria for benefits decisions. In Germany, representation of stakeholders and transparency of procedures can be improved. Consistency of decision-making is hindered by the veto positions of selected stakeholders. Moreover, benefit decisions are made for different healthcare sectors separately. In Switzerland, transparency of procedures is virtually non-existent at the moment. Thus, it is impossible to assess the consistency of decision-making. Only in England the costs of healthcare services influence the decision to include or exclude them.
Gress
Stefan
S
Department of Economics, Institute of Health Care Management, University of Essen-Duisburg, 45117 Essen, Germany.
Niebuhr
Dea
D
Rothgang
Heinz
H
Wasem
Jürgen
J
D017047:Cost Sharing; D003362:Cost-Benefit Analysis; D003659:Decision Making, Organizational; D004739:England; D005858:Germany; D006292:Health Priorities / Q000145:classification*; D006801:Humans; D007342:Insurance Benefits / Q000145:classification* / Q000191:economics; D009313:National Health Programs / Q000191:economics*; D011050:Policy Making; D019057:Quality-Adjusted Life Years; D013222:State Medicine / Q000191:economics*; D013557:Switzerland; D014481:United States