[Priority setting in healthcare. What can Germany learn from other countries?].
Internationally, priority setting has been debated since the late 1980s, partly only regarding underlying principles, but partly with real implications for the benefit basket. Whereas all approaches reviewed (Norway, Sweden, Denmark, Oregon, The Netherlands, New Zealand) are convincing, those that relied on public consensus and left the priority-setting principles to the discretion of individual healthcare professionals had no effect as early prioritization efforts in the Scandinavian countries show. Prioritization approaches that have relied on concrete lists of indication-treatment pairs (for example, in the U.S. state of Oregon across all areas of care and in Sweden the form of guidelines within indication groups) have led to changes but not always to the expected results: expenditure was only moderately reduced but the provision of care has become more transparent. Regardless of the differences between the various countries, they have several things in common: a heated public debate, a very long implementation timeline, and the lack of a (much feared) prioritization according to age, gender, or social status. Recently, priority setting has been seen as complementary to health technology assessments, guidelines, and quality assurance, all with their own focuses.
Busse
R
R
Fachgebiet Management im Gesundheitswesen, Technische Universität Berlin, Sekr. H80, Str. des 17 Juni 135, 10623 Berlin. rbusse@tu-berlin.de
Hoffmann
C
C
D017046:Cost Savings / Q000191:economics; D003431:Cross-Cultural Comparison; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration; D005858:Germany; D015276:Health Care Rationing / Q000191:economics / Q000458:organization & administration*; D005102:Health Expenditures; D006287:Health Planning Guidelines; D006292:Health Priorities / Q000191:economics / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration; D006301:Health Services Needs and Demand / Q000191:economics / Q000458:organization & administration; D006801:Humans; D009313:National Health Programs / Q000191:economics / Q000458:organization & administration*