Decisions on Inclusion in the Swedish Basic Health Care Package—Roles of Cost-Effectiveness and Need
- Lars Bernfort
- … show all 1 hide
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Background: Inclusion or not of a treatment strategy in the publicly financed health care is really a matter of prioritisation. In Sweden priority setting decisions are governed by law in which it is stated that decisions should be guided by firstly the principle of need and secondly the principle of cost-effectiveness.
Objective: The purpose of the paper is to discuss and illustrate the roles of need and cost-effectiveness in decisions on inclusion or not of treatment strategies in the publicly financed health care.
Methods: The theoretical backgrounds of need and cost-effectiveness are discussed in short, both with respect to their meaning and to their potential roles in decisions on priority setting. Four treatment strategies, Viagra, Rivastigmine, statins, and lung transplants, are analysed with respect to whether either cost-effectiveness or need, or both, seem to have played a role in the decisions of inclusion or not in the basic health care package.
Results: Both need and cost-effectiveness are important and should be important aspects when making decisions on priority setting. From the examples of the four treatment strategies it seems that decisions are almost exclusively made with reference to the principle of need.
Conclusions: The most evident conclusion to be drawn from this study is that decisions on priority setting are almost solely based on the principle of need. This implies that the principle of cost-effectiveness is given very little space, which is a problem as this means an obvious risk of inefficient resource use.
- Bentham, J. (1988) The Principles of Morals and Legislation (new ed.). Amherst, NY: Prometheus.
- Daniels, N. (1985) Just Health Care. Cambridge, UK: Cambridge University Press.
- Hirschleifer, J., and Glazer, A. (1992) Price Theory and Aplications (5th ed.). Englewood Cliffs, NJ: Prentice-Hall.
- Klose, T. (1999) The Contingent Valuation Method in Health Care. Health Policy 47, 97-123.
- Liss, P.-E. (1993) Health care need. Aldershot: Avebury.
- Liss, P.-E. (1999) Setting Goals in Health Promotion. A Conceptual and Ethical Platform. Medicine, Health Care and Philosophy 3, 169-173.
- Luce, B., and Elixhauser, A. (1990) Standards for Socioeconomic Evaluations of Health Care Products and Services. Heidelberg, Germany: Springer-Verlag.
- Luenberger, D.G. (1995) Microeconomic Theory (international ed.). New York: McGraw-Hill.
- Mill, J.S. (1969) The Collected Works of John Stuart Mill (Vol. 10). Toronto: University of Toronto Press.
- Mooney, G.H. (1977) The Valuation of Human Life. London: MacMillan.
- Pearce, D.W., and Nash C.A. (1981) The Social Appraisal of Projects. A Text in Cost-Benefit Analysis (4th ed.). London: MacMillan.
- Rawls, J. (1971) A Theory of Justice. London: Oxford University Press.
- Sahlin, J. (2000) Hälso-och sjukvårdslagen: med kommentarer. [The Swedish Health and Medical Services Act: With Comments] (6th ed.). Stockholm: Norstedts Juridik.
- SOU (1995:5) Priorities in Health Care—Ethics, Economy, Implementation. Final report by the Swedish Parliamentary Priorities Commission. Socialdepartementet. [Department of social affairs]. Stockholm: Fritzes.
- Decisions on Inclusion in the Swedish Basic Health Care Package—Roles of Cost-Effectiveness and Need
Health Care Analysis
Volume 11, Issue 4 , pp 301-308
- Cover Date
- Print ISSN
- Online ISSN
- Kluwer Academic Publishers-Plenum Publishers
- Additional Links
- priority setting
- basic health care
- health care resources
- Lars Bernfort (1)
- Author Affiliations
- 1. Center for Medical Technology Assessment, Linkoping University, Linkoping, Sweden