Table 3 Overview of centralized priority setting efforts

Country

Principles, guidelines, recommendations

   Year

   Process

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