Pornak S, Meyer T, Raspe H
Institut für Sozialmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Germany.
Gesundheitswesen. 2011 Oct;73(10):680-7. doi: 10.1055/s-0031-1280841. Epub 2011 Jul 27.
Priority setting in medicine helps to achieve a fair and transparent distribution of health-care resources. The German discussion about priority setting is still in its infancy and may benefit from other countries' experiences. This paper aims to analyse the Danish priority setting debate in order to stimulate the German discussion. The methods used are a literature analysis and a document analysis as well as expert interviews. The Danish debate about priority setting in medicine began in the 1970s, when a government committee was constituted to evaluate health-care priorities at the national level. In the 1980s a broader debate arose in politics, ethics, medicine and health economy. The discussions reached a climax in the 1990s, when many local activities - always involving the public - were initiated. Some Danish counties tried to implement priority setting in the daily routine of health care. The Council of Ethics was a major player in the debate of the 1990s and published a detailed statement on priority setting in 1996. With the new century the debate about priority setting seemed to have come to an end, but in 2006 the Technology Council and the Danish Regions resumed the discussion. In 2009 the Medical Association called for a broad debate in order to achieve equity among all patients. The long lasting Danish debate on priority setting has entailed only very little practical consequences on health care. The main problems seem to have been the missing effort to bundle the various local initiatives on a national level and the lack of powerful players to put results of the discussion into practice. Nevertheless, today the attitude towards priority setting is predominantly positive and even politicians talk freely about it.
医学领域的优先事项设定有助于实现医疗资源的公平、透明分配。德国关于优先事项设定的讨论仍处于起步阶段,或许能从其他国家的经验中受益。本文旨在分析丹麦的优先事项设定辩论,以推动德国的相关讨论。所采用的方法包括文献分析、文件分析以及专家访谈。丹麦关于医学领域优先事项设定的辩论始于20世纪70年代,当时成立了一个政府委员会来评估国家层面的医疗保健优先事项。20世纪80年代,政治、伦理、医学和卫生经济领域展开了更广泛的辩论。讨论在20世纪90年代达到高潮,当时发起了许多地方活动——始终有公众参与。一些丹麦郡县试图在日常医疗保健中实施优先事项设定。伦理委员会是20世纪90年代辩论的主要参与者,并于1996年发表了一份关于优先事项设定的详细声明。进入新世纪,关于优先事项设定的辩论似乎已经结束,但在2006年,技术委员会和丹麦各地区重新展开了讨论。2009年,医学协会呼吁进行广泛辩论,以实现所有患者之间的公平。丹麦关于优先事项设定的长期辩论在医疗保健方面仅产生了极少的实际影响。主要问题似乎在于缺乏在国家层面整合各种地方倡议的努力,以及缺乏有影响力的参与者将讨论结果付诸实践。尽管如此,如今对优先事项设定的态度总体上是积极的,甚至政治家们也能自由地谈论它。