Busse R, Hoffmann C
Fachgebiet Management im Gesundheitswesen, Technische Universität Berlin, Sekr. H80, Str. des 17 Juni 135, 10623 Berlin.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2010 Sep;53(9):882-9. doi: 10.1007/s00103-010-1115-y.
Internationally, priority setting has been debated since the late 1980s, partly only regarding underlying principles, but partly with real implications for the benefit basket. Whereas all approaches reviewed (Norway, Sweden, Denmark, Oregon, The Netherlands, New Zealand) are convincing, those that relied on public consensus and left the priority-setting principles to the discretion of individual healthcare professionals had no effect as early prioritization efforts in the Scandinavian countries show. Prioritization approaches that have relied on concrete lists of indication-treatment pairs (for example, in the U.S. state of Oregon across all areas of care and in Sweden the form of guidelines within indication groups) have led to changes but not always to the expected results: expenditure was only moderately reduced but the provision of care has become more transparent. Regardless of the differences between the various countries, they have several things in common: a heated public debate, a very long implementation timeline, and the lack of a (much feared) prioritization according to age, gender, or social status. Recently, priority setting has been seen as complementary to health technology assessments, guidelines, and quality assurance, all with their own focuses.
在国际上，自20世纪80年代末以来，就一直在讨论优先事项的确定，部分讨论仅涉及基本原则，但部分讨论对福利篮子有实际影响。尽管所审查的所有方法（挪威、瑞典、丹麦、俄勒冈州、荷兰、新西兰）都很有说服力，但那些依赖公众共识并将优先事项确定原则留给个别医疗保健专业人员自行决定的方法却没有效果，正如斯堪的纳维亚国家早期的优先排序努力所显示的那样。依赖具体的适应症-治疗对清单的优先排序方法（例如，在美国俄勒冈州的所有护理领域以及在瑞典以适应症组内的指南形式）已经带来了变化，但并不总是带来预期的结果：支出仅适度减少，但护理的提供变得更加透明。尽管各国之间存在差异，但它们有几个共同点：激烈的公众辩论、非常长的实施时间表，以及缺乏（人们非常担心的）根据年龄、性别或社会地位进行的优先排序。最近，优先事项的确定被视为对卫生技术评估、指南和质量保证的补充，所有这些都有各自的重点。
