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Table 3 Overview of centralized priority setting efforts

From: Priority setting in health care: Lessons from the experiences of eight countries

Country Principles, guidelines, recommendations
Norway Priority principles:
   1987/1997 Lønning Committee I and II    • Severity
     • Potential effect
     • Cost-effectiveness
  Priority groups based on severity (and later funding):
     • Fundamental
     • Supplementary
     • Low priority
     • No public funding
The Netherlands Sieves/filters to determine basic package of services:
   1992/1995 Dutch Committee on Choices in Health Care (Dunning Committee)    • Is care necessary?
     • Is care efficient?
     • Is care effective?
     • Can care be left up to individual responsibility?
Sweden Ethical platform principles:
   1993/1995 Commission of Parliament members and experts    • Human dignity
     • Need and solidarity
     • Cost-efficiency
  Political/administrative and clinical priority groups:
     • Life-threatening acute diseases, severe chronic diseases and palliative terminal care
     • Prevention and habilitation/rehabilitation
     • Less severe acute diseases
     • Borderline cases
     • Care for reasons other than disease
Denmark Core values:
   1997 Danish Council of Ethics    • Equal human worth
     • Solidarity
     • Security and safety
     • Freedom and self-determination
  General goal, framed in terms of "opportunity for self-expression...irrespective of social background and economic ability"
  Partial goals:
     • Social and geographical equity
     • Quality
     • Cost-effectiveness
     • Democracy and consumer influence
Israel Criteria for prioritization of recommended technologies:
   1995 Medical Technology Forum and National Advisory Committee, In response to new National Health Insurance Law    • Life-saving technology with full recovery
     • Potential to prevent mortality or morbidity
     • Number of patients to benefit
     • Financial burden on society and the patient
     • New technology for diseases with no alternative treatments available
     • Brings increase in longevity and quality of life
     • Benefits of reducing morbidity vs. improving quality of life
     • Net gain is higher than short- or long-term cost
     • Funding of efficacious treatment than is expensive to the individual, but of reasonable cost to society
New Zealand Set out principles to guide priority setting decisions:
   Yearly, beginning in 1993 Core Services Committee/National Health Committee    • Effectiveness
     • Efficiency
     • Equity
     • Acceptability
  'Consensus conferences' for specialized services;
  Recommend core services for given year
Oregon (US) Developed Quality of Well-Being Scale;
   Beginning in 1989 Health Services Commission Used scale to establish cost-effectiveness rankings;
  Revised rankings after public backlash;
  Continued to use ranked list of condition-treatment pairs
  Recently more emphasis on evidence base for recommendations
UK Appraisal of new health technologies;
   Ongoing, beginning in 1999 National Institute for Clinical Excellence (NICE) Development of clinical guidelines;
  Explicit use of cost-effectiveness evaluations
  Appeal possible on narrow grounds