Sandman Lars, Hofmann Björn
Department of Medical and Health Sciences, National Center for Priority Setting in Health-Care, Linköping University, Linköping, Sweden.
Institute for the Health Sciences, The Norwegian University for Science and Technology (NTNU) Gjøvik, PO Box 191, 2802, Gjøvik, Norway.
Health Care Anal. 2019 Mar;27(1):26-44. doi: 10.1007/s10728-018-0361-2.
In health care priority setting different criteria are used to reflect the relevant values that should guide decision-making. During recent years there has been a development of value frameworks implying the use of multiple criteria, a development that has not been accompanied by a structured conceptual and normative analysis of how different criteria relate to each other and to underlying normative considerations. Examples of such criteria are unmet need and severity. In this article these crucial criteria are conceptually clarified and analyzed in relation to each other. We argue that disease-severity and condition-severity should be distinguished and we find the latter concept better reflects underlying normative values. We further argue that unmet need does not fulfil an independent and relevant role in relation to condition-severity except for in some limited situations when having to distinguish between conditions of equal severity (and where other features also equals each other).
在医疗保健的优先事项设定中，会使用不同的标准来反映应指导决策的相关价值观。近年来，出现了一些价值框架，意味着要使用多种标准，但这一发展并未伴随着对不同标准如何相互关联以及与潜在规范考量之间关系的结构化概念和规范分析。此类标准的例子包括未满足的需求和严重程度。在本文中，这些关键标准在概念上得到了澄清，并相互进行了分析。我们认为，应区分疾病严重程度和病情严重程度，并且我们发现后一概念能更好地反映潜在的规范价值观。我们进一步认为，未满足的需求在与病情严重程度相关方面，除了在某些有限的情况下，即在必须区分同等严重程度的病情（且其他特征也彼此相等）时，并不发挥独立且相关的作用。
