title: Balancing equity and efficiency in the Dutch basic benefits package using the principle of proportional shortfall.
abstract: Economic evaluations are increasingly used to inform decisions regarding the allocation of scarce health care resources. To systematically incorporate societal preferences into these evaluations, quality-adjusted life year gains could be weighted according to some equity principle, the most suitable of which is a matter of frequent debate. While many countries still struggle with equity concerns for priority setting in health care, the Netherlands has reached a broad consensus to use the concept of proportional shortfall. Our study evaluates the concept and its support in the Dutch health care context. We discuss arguments in the Netherlands for using proportional shortfall and difficulties in transitioning from principle to practice. In doing so, we address universal issues leading to a systematic consideration of equity concerns for priority setting in health care. The article thus has relevance to all countries struggling with the formalization of equity concerns for priority setting.
authors.affiliation: Institute for Medical Technology Assessment and Institute of Health Policy and Management, Erasmus University Rotterdam, 3000 DR, Rotterdam, The Netherlands. vandewetering@bmg.eur.nl
authors.forename: E J
authors.initials: EJ
authors.lastname: van de Wetering
authors.forename: E A
authors.initials: EA
authors.lastname: Stolk
authors.forename: N J A
authors.initials: NJ
authors.lastname: van Exel
authors.forename: W B F
authors.initials: WB
authors.lastname: Brouwer
mesh_terms: D003210:Concept Formation; D003362:Cost-Benefit Analysis; D019981:Health Care Sector / Q000191:economics*; D006295:Health Resources / Q000191:economics* / Q000458:organization & administration*; D006801:Humans; D009313:National Health Programs; D009426:Netherlands; D019057:Quality-Adjusted Life Years; D012945:Social Values