Hermans H, den Exter A
Institute of Health Policy and Management, Erasmus University Rotterdam, 30000 DR Rotterdam, The Netherlands.
Croat Med J. 1998 Sep;39(3):346-55.
Since 1990, the priority-setting has become one of the key issues in making choices in health care. In 1991, the now famous Dunning Report was presented to the Dutch Cabinet. One of its main conclusions was that health services should satisfy four criteria: necessary care, effectiveness, efficiency, and individual responsibility. Priority-setting can be done either by excluding medical treatments from compulsory health insurance coverage and/or by the use of both protocols and guidelines, and the individual selection of patients by health professionals. The discussion on the introduction of in vitro fertilization into the basic health insurance package and the exclusion of dental care for adults have shown that, on the basis of the Dunning criteria, it is not easy to leave complete or parts of services out of the basic health insurance package. The second strategy - the application of the Committee's criteria by the use of protocols, guidelines, and budget restrictions - is even more difficult to realize. More patients assert their right to health care benefits before courts. The courts' decisions have shown that it is difficult for the patient's counsellor to prove that government is responsible for non-delivery due to force majeur. Courts attach much importance to the Dunning criteria; in particular the criterion of necessity.
自1990年以来，确定优先事项已成为医疗保健选择中的关键问题之一。1991年，著名的邓宁报告提交给了荷兰内阁。其主要结论之一是，卫生服务应满足四个标准：必要的护理、有效性、效率和个人责任。确定优先事项可以通过将某些医疗治疗排除在强制性医疗保险范围之外和/或通过使用协议和指南以及卫生专业人员对患者的个人选择来实现。关于将体外受精纳入基本医疗保险套餐以及排除成人牙科护理的讨论表明，根据邓宁标准，要将全部或部分服务排除在基本医疗保险套餐之外并非易事。第二种策略——通过使用协议、指南和预算限制来应用委员会的标准——甚至更难实现。越来越多的患者向法院主张其获得医疗保健福利的权利。法院的判决表明，患者顾问很难证明政府因不可抗力而对未提供服务负有责任。法院非常重视邓宁标准；特别是必要性标准。
