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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


Principles, guidelines, recommendations






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?


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


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


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


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