title: A new proposal for priority setting in Norway: Open and fair.
abstract: Health systems worldwide struggle to meet increasing demands for health care, and Norway is no exception. This paper discusses the new, comprehensive framework for priority setting recently laid out by the third Norwegian Committee on Priority Setting in the Health Sector. The framework posits that priority setting should pursue the goal of "the greatest number of healthy life years for all, fairly distributed" and centres on three criteria: 1) The health-benefit criterion: The priority of an intervention increases with the expected health benefit (and other relevant welfare benefits) from the intervention; 2) The resource criterion: The priority of an intervention increases, the less resources it requires; and 3) The health-loss criterion: The priority of an intervention increases with the expected lifetime health loss of the beneficiary in the absence of such an intervention. Cost-effectiveness plays a central role in this framework, but only alongside the health-loss criterion which incorporates a special concern for the worse off and promotes fairness. In line with this, cost-effectiveness thresholds are differentiated according to health loss. Concrete implementation tools and open processes with user participation complement the three criteria. Informed by the proposal, the Ministry of Health and Care Services is preparing a report to the Parliament, with the aim of reaching political consensus on a new priority-setting framework for Norway.
authors: Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5018 Bergen, Norway. Electronic address: trygve.ottersen@uib.no.
authors: Trygve
authors: T
authors: Ottersen
authors: Centre for Medical Ethics, University of Oslo, PO Box 1130, Blindern, 0318 Oslo, Norway. Electronic address: reidun.forde@medisin.uio.no.
authors: Reidun
authors: R
authors: Førde
authors: Department of Technology and eHealth, South-Eastern Norway Regional Health Authority, PO Box 404, 2303 Hamar, Norway. Electronic address: meetali.kakad@helse-sorost.no.
authors: Meetali
authors: M
authors: Kakad
authors: Department of Health Science, University of Stavanger, 4036 Stavanger, Norway. Electronic address: alice.kjellevold@uis.no.
authors: Alice
authors: A
authors: Kjellevold
authors: Department of Health Management and Health Economics, University of Oslo, PO Box 1089 Blindern, 0318 Oslo, Norway. Electronic address: h.o.melberg@medisin.uio.no.
authors: Hans Olav
authors: HO
authors: Melberg
authors: Department of Neonatology, Oslo University Hospital, PO Box 4950, 0424 Oslo, Norway. Electronic address: atlemoen@me.com.
authors: Atle
authors: A
authors: Moen
authors: Akershus University Hospital, PO Box 1000, 1478 Lørenskog, Norway. Electronic address: anen.ringard@ahus.no.
authors: Ånen
authors: Å
authors: Ringard
authors: Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5018 Bergen, Norway. Electronic address: ole.norheim@uib.no.
authors: Ole Frithjof
authors: OF
authors: Norheim
mesh_terms: D003362:Cost-Benefit Analysis / Q000458:organization & administration; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration; D006291:Health Policy; D006292:Health Priorities / Q000458:organization & administration; D006801:Humans; D009664:Norway; D011050:Policy Making; D019057:Quality-Adjusted Life Years
keywords: Economics; Ethics; Evidence-based medicine; Health care rationing; Health care reform; Health policy; Jurisprudence; Patient participation; Politics; Social justice