Priorisierung im Gesundheitswesen: Was können wir aus den internationalen Erfahrungen lernen?

Abstract

In contrast to Germany, several other countries started to develop methods for setting priorities in health care more than 20 years ago. This paper provides an overview of the experiences in Norway, Sweden, the Netherlands, the United Kingdom and the US state of Oregon. Acknowledging the fact that - due to the increasing discrepancy between medical demand and publicly available financial resources--it is inevitable to set limits in health care, these countries initiated a public discourse on resource allocation in health care and established national committees to develop methods for the prioritisation of health care services. In most countries, priorities were implemented by practice guidelines defining clinical indications for medical interventions. In addition to this explicit allocation of scarce health care resources most countries also rely on implicit cost-containment measures (e.g., prospective reimbursement systems). Finally the article will highlight the conclusions that may be drawn from these international experiences for the German health care system.