Content area
Full Text
Articles
Introduction
Priority setting in health care is a necessary, but difficult and complex task that can be tackled in different ways. Some countries have chosen to address this challenge by adopting a set of principles or criteria that are to be applied to a wide range of priority-setting decisions, often reflecting broader public debates about what values are relevant for rationing (see, e.g. Calltorp, 1999; Berg and van der Grinten, 2003; Landwehr and Klinnert, 2015; Rumbold et al., forthcoming). Norway is one of the countries that has spearheaded this approach. Concerted efforts have been made from an early stage to take a systematic approach to priority setting, and through the work of several national commissions, a set of three official priority-setting criteria has been developed, in principle applicable to all kinds of priority-setting decisions (Norheim, 2003; Kapiriri et al., 2007) (Table 1).
Table 1
The three official priority-setting criteria
The three official priority-setting criteria | |
Severity of health state | As determined by prognosis for loss of life, diminished physical or mental functioning, and pain |
Expected benefit of treatment | As determined by increased probability of survival, improved physical or mental functioning, and reduced pain |
Cost-effectiveness of treatment | The costs should stand in a reasonable relation to the benefits of the treatment |
(NOU, 1997; Norheim, 2003) | |
The criteria are to be applied together, such that a treatment must meet all three criteria in order to be given priority. The criteria were intended as overarching criteria for priority-setting at all levels of the health care services (NOU, 1997; Directorate of Health, 2012), and are reflected both in legislation and in practice in various ways. Importantly, until 2015, the criteria were codified in the Patient Rights Act (LOV-1999-07-02-63) and its section 2.1b, Regulation on Priority Setting (FOR-2000-12-01-1208). This law grants patients a right to health care, provided that the health condition is severe and that the costs of treatment are 'reasonable' relative to the expected benefit. The criteria are also embedded in the Regulation on Medicines (FOR-2010-06-23-957), which governs the evaluation of new drugs for inclusion in the prescription reimbursement scheme (NOU, 2014; Wisløff, 2015). |
While the criteria themselves have been subject to extensive public debate and several revisions - most recently in the work of the...