Priority setting in health care: Swedish efforts and experiences

Abstract

Nearly 20 years ago, the Swedish Government called for a parliamentary commission to discuss the role of health services in a welfare society, emphasising the basic ethical principles that should guide the necessary prioritisation of health resources. Then, prioritisation was a new concept for most people. Today, a growing number of people are aware that resources in health care are limited and setting priorities is something which is going on all the time, but very seldom explicitly. Still, priority setting becomes very controversial when you try to carry it out in a systematic and open way. In common terminology, to prioritise means to place something in rank order and choose. Rank order can be determined at different levels and can involve two or more options. At the political level it could mean ranking care needs in society or a doctor ranking various treatment alternatives for an individual patient. The prioritisation concept also involves using the rank order to determine, e.g., the option of being allocated new resources or the option of being rationed. Before a rank order or a choice can be viewed as prioritisation it must meet certain requirements. First, the alternatives must be considered. Second, these alternatives must be viable options that could actually be considered. The term ‘rationing’ is not used as frequently as ‘prioritisation’ in discussions on allocating resources in health care and social services. Rationing aims at bridging the gap between need and available resources by limiting the possibilities to fully meet the need. Priority setting in a decentralised health care system Priority setting is relevant at all levels in the health care system. At the national level, the Parliament, Government, and National Board of Health and Welfare issue laws and regulations and give support to decision making through professional guidelines, thereby influencing county councils and municipalities responsible for health care. The county level runs the hospitals and most health centres. The municipality level is responsible for elderly care and nursing homes. Municipalities levy taxes.