Marckmann Georg
Institut für Ethik und Geschichte der Medizin, Universität Tübingen.
Z Evid Fortbild Qual Gesundhwes. 2009;103(2):85-91. doi: 10.1016/j.zefq.2009.02.012.
In contrast to Germany, several other countries started to develop methods for setting priorities in health care more than 20 years ago. This paper provides an overview of the experiences in Norway, Sweden, the Netherlands, the United Kingdom and the US state of Oregon. Acknowledging the fact that - due to the increasing discrepancy between medical demand and publicly available financial resources--it is inevitable to set limits in health care, these countries initiated a public discourse on resource allocation in health care and established national committees to develop methods for the prioritisation of health care services. In most countries, priorities were implemented by practice guidelines defining clinical indications for medical interventions. In addition to this explicit allocation of scarce health care resources most countries also rely on implicit cost-containment measures (e.g., prospective reimbursement systems). Finally the article will highlight the conclusions that may be drawn from these international experiences for the German health care system.
与德国不同，其他几个国家在20多年前就开始研发医疗保健领域确定优先事项的方法。本文概述了挪威、瑞典、荷兰、英国以及美国俄勒冈州的相关经验。鉴于医疗需求与公共可用财政资源之间的差距日益增大，在医疗保健领域设定限制不可避免，这些国家发起了关于医疗保健资源分配的公开讨论，并成立了国家委员会来研发医疗保健服务优先排序的方法。在大多数国家，优先事项通过定义医疗干预临床适应症的实践指南来实施。除了这种对稀缺医疗保健资源的明确分配外，大多数国家还依赖隐性成本控制措施（例如，前瞻性报销系统）。最后，本文将重点阐述从这些国际经验中可以为德国医疗保健系统得出何种结论。
