Dear list members and Shaun
I know of one project in Oxfordshire Health Authority, known as the
Oxford Priorities Forum, which has used specific criteria and evidence
to decide which treatments should be included or should not be included
in the health services in their county. However, they have found that
it is as important to concentrate on the process by which the decisions
have been made as the rationing criteria or evidence.
There has also been work completed by Homa Hasan and Prof. Jan Helge
Solbakk in the University of Oslo on prioritisation and genetic
screening in connection with the recommendations for prioritisation with
the Norwegian framework. Homa Hasan can be contacted on homa hasan
<[log in to unmask]>
A book, 'Ethics and Public Health' containing chapters from these
authors will be published by Routledge Press later this year.
Best wishes
Peter
The contact person is the Director of Public Health, Sian Griffiths,
Sian Griffiths <[log in to unmask]>
In message <000d01be9b18$e97a9d80$31aafea9@gfmedctr>, Dr Jon Wilcox
<[log in to unmask]> writes
>This seems pretty radical thinking for a Scandinavian country.
>The levels of state-funded care have always been perceived as comprehensive
>over there though perhaps things are changing.
>JW
>-----Original Message-----
>From: Treweek, Shaun <[log in to unmask]>
>To: [log in to unmask]
><[log in to unmask]>
>Date: Tuesday, May 11, 1999 12:13
>Subject: Prioritisation and evidence
>
>
>>Dear List,
>>
>>I am a member of the organising committee for my department's (Health
>>Services Research Unit, Folkehelsa, Oslo) two-day annual seminar. This
>year
>>we are planning to spend one day discussing prioritisation in health care
>>and, in particular, the use of evidence-based medicine in decision-making.
>>The Norwegian Government has produced a prioritisation document that
>divides
>>health services into four groups called, roughly, Basic services,
>>Supplementary Services, Low priority services and Services not offered by
>>the state.
>>
>>Within this framework, for example, a service that has a very high cost
>>relative to the anticipated benefit would not be offered by the state. A
>>patient with a greater than 10% chance of death within the next five years
>>for whom a treatment offered at 'reasonable' cost would increase their
>>five-year survival would be offered this treatment as part of Basic
>>services.
>>
>>My question is this: is anyone aware of work that has been done that
>>explicitly makes use of published medical evidence (Cochrane reviews, say)
>>to make decisions about prioritisation, particularly at the individual
>>patient level. How would a doctor decide that a particular patient could
>be
>>treated under Basic services in the Norwegian example? My impression with
>>the Norwegian document is that it doesn't influence doctors' behaviour a
>>great deal. Does anyone know of an example where doctors do make explicit
>>priority decisions following a set of guidelines? The Oregon system?
>>
>>If anyone can offer any help, advice or pointers to further information,
>I'd
>>be extremely happy to receive it. I'll send out a summary of responses to
>>the whole list in due course.
>>
>>Many thanks,
>>
>>Shaun Treweek
>>
>>Dr Shaun Treweek, Research Fellow
>>Health Services Research Unit (SAHT)
>>National Institute of Public Health
>>PO Box 4404 Torshov
>>0403 Oslo
>>Norway
>>
>>Tel.: +47 22 04 22 71
>>Fax.: +47 22 04 25 95
>>e-mail (work): [log in to unmask]
>>e-mail (home): [log in to unmask]
>>
>
Peter Bradley
Highfield Tel direct +44 1604 615251
Northamptonshire Health Authority Tel general +44 1604 615000
Cliftonville Road Tel secretary +44 1604 615208
Northampton NN1 5DN Fax in office +44 1604 615146
England Personal Fax +44 870 164 1289
e-mail:[log in to unmask]
or [log in to unmask]
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