In article <[log in to unmask]>, Peter Bradley
<[log in to unmask]> writes
>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.
Quite.
The North Wales Priority Setting Demonstration Project
North Wales Health Authority is undertaking a Prioritisation
Demonstration Project to help inform its new Cancer strategy. The
Prioritisation Demonstration Project is exploring the potential of a
prioritisation model successfully used by Gwynedd Health Authority
between 1992 and 1996. The criteria used in the model are summarised in
the table 2.
(The enclosed is in rtf format and should be perfectly safe! It's a
brief summary of the current North Wales initiative.)
[ Section: 1/1 File: CHAP2(~1.rtf.doc UUencoded by: Turnpike Integrated Version 4.02 U ]
begin 644 CHAP2(~1.rtf.doc
M>UQR=&8Q7&%N<VE<86YS:6-P9S$R-3)<=6,Q(%QD969F,3)<9&5F;&%N9S$P
M,S-<9&5F;&%N9V9E,3`S,WM<9F]N='1B;'M<9C!<9G)O;6%N7&9C:&%R<V5T
M,%QF<')Q,GM<*EQP86YO<V4@,#(P,C`V,#,P-3`T,#4P,C`S,#1]5&EM97,@
M3F5W(%)O;6%N.WU[7&8Q7&9S=VES<UQF8VAA<G-E=#!<9G!R<3)[7"I<<&%N
M;W-E(#`R,&(P-C`T,#(P,C`R,#(P,C`T?4%R:6%L.WU[7&8S7&9R;VUA;EQF
M8VAA<G-E=#)<9G!R<3)[7"I<<&%N;W-E(#`U,#4P,3`R,#$P-S`V,#(P-3`W
M?5-Y;6)O;#M]>UQF-%QF<F]M86Y<9F-H87)S970P7&9P<G$R>UPJ7'!A;F]S
M92`P,#`P,#`P,#`P,#`P,#`P,#`P,'U4:6UE<WM<*EQF86QT(%1I;65S($YE
M=R!2;VUA;GT[?7M<9C$R7&9R;VUA;EQF8VAA<G-E=#!<9G!R<3)[7"I<<&%N
M;W-E(#`P,#`P,#`P,#`P,#`P,#`P,#`P?4YE=R!9;W)K>UPJ7&9A;'0@5&EM
M97,@3F5W(%)O;6%N?3M]>UQF,35<9G-W:7-S7&9C:&%R<V5T,%QF<')Q,GM<
M*EQP86YO<V4@,#(P8C`V,#0P,S`U,#0P-#`R,#1]5&%H;VUA.WU[7&8Q-#9<
M9G-W:7-S7&9C:&%R<V5T,C,X7&9P<G$R(%1A:&]M82!#13M]>UQF,30W7&9S
M=VES<UQF8VAA<G-E=#(P-%QF<')Q,B!486AO;[log in to unmask][7&8Q-#E<9G-W
M:7-S7&9C:&%R<V5T,38Q7&9P<G$R(%1A:&]M82!'<F5E:SM]>UQF,34P7&9S
M=VES<UQF8VAA<G-E=#$V,EQF<')Q,B!486AO;[log in to unmask][7&8Q-3%<9G-W
M:7-S7&9C:&%R<V5T,3@V7&9P<G$R(%1A:&]M82!"86QT:6,[?7U[7&-O;&]R
M=&)L.UQR960P7&=R965N,%QB;'5E,#M<<F5D,%QG<F5E;C!<8FQU93(U-3M<
M<F5D,%QG<F5E;C(U-5QB;'5E,C4U.UQR960P7&=R965N,C4U7&)L=64P.UQR
M960R-35<9W)E96XP7&)L=64R-34[7')E9#(U-5QG<F5E;C!<8FQU93`[7')E
M9#(U-5QG<F5E;C(U-5QB;'5E,#M<<F5D,C4U7&=R965N,C4U7&)L=64R-34[
M7')E9#!<9W)E96XP7&)L=64Q,C@[7')E9#!<9W)E96XQ,CA<8FQU93$R.#M<
M<F5D,%QG<F5E;C$R.%QB;'5E,#M<<F5D,3(X7&=R965N,%QB;'5E,3(X.UQR
M960Q,CA<9W)E96XP7&)L=64P.UQR960Q,CA<9W)E96XQ,CA<8FQU93`[7')E
M9#$R.%QG<F5E;C$R.%QB;'5E,3(X.UQR960Q.3)<9W)E96XQ.3)<8FQU93$Y
M,CM]>UQS='EL97-H965T>UQW:61C=&QP87)<861J=7-T<FEG:'0@7&8Q,EQL
M86YG,C`U-UQC9W)I9"!<<VYE>'0P($YO<FUA;#M]>UQS,5QK965P;EQW:61C
M=&QP87)<861J=7-T<FEG:'0@7&8T7&QA;F<R,#4W7&-G<FED(%QS8F%S961O
M;C`@7'-N97AT,"!H96%D:6YG(#$[?7M<<S)<<6I<:V5E<&Y<=VED8W1L<&%R
M7&%D:G5S=')I9VAT(%QB7&8T7&QA;F<R,#4W7&-G<FED(%QS8F%S961O;C`@
M7'-N97AT,"!H96%D:6YG(#([?7M<<S-<<6I<:V5E<&Y<=VED8W1L<&%R7&%D
M:G5S=')I9VAT(%QF-%QF<S,R7&QA;F<R,#4W7&-G<FED(%QS8F%S961O;C`@
M7'-N97AT,"!H96%D:6YG(#,[?7M<<S1<<6I<:V5E<&Y<=VED8W1L<&%R7&%D
M:G5S=')I9VAT(%QB7&8T7&9S,S)<;&%N9S(P-3=<8V=R:60@7'-B87-E9&]N
M,"!<<VYE>'0P(&AE861I;F<@-#M]>UQS-5QK965P;EQW:61C=&QP87)<861J
M=7-T<FEG:'0@7&)<9C1<9G,S,EQL86YG,C`U-UQC9W)I9"!<<V)A<V5D;VXP
M(%QS;F5X=#`@:&5A9&EN9R`U.WU[7',V7&ME97!N7'=I9&-T;'!A<EQA9&IU
M<W1R:6=H="!<8EQF-%QL86YG,C`U-UQC9W)I9"!<<V)A<V5D;VXP(%QS;F5X
M=#`@:&5A9&EN9R`V.WU[7"I<8W,Q,"!<861D:71I=F4@1&5F875L="!087)A
M9W)A<&@@1F]N=#M]>UQS,35<=VED8W1L<&%R7'1Q8UQT>#0Q-3-<='%R7'1X
M.#,P-EQA9&IU<W1R:6=H="!<9C1<9G,R,%QL86YG,C`U-UQC9W)I9"!<<V)A
M<V5D;VXP(%QS;F5X=#$U(&9O;W1E<CM]>UQS,39<=VED8W1L<&%R7'1Q8UQT
M>#0Q-3-<='%R7'1X.#,P-EQA9&IU<W1R:6=H="!<9C1<9G,R,%QL86YG,C`U
M-UQC9W)I9"!<<V)A<V5D;VXP(%QS;F5X=#$V(&AE861E<CM]>UQS,3=<=VED
M8W1L<&%R7&%D:G5S=')I9VAT(%QF-%QF<S(P7&QA;F<R,#4W7&-G<FED(%QS
M8F%S961O;C`@7'-N97AT,3<@96YD;F]T92!T97AT.WU[7',Q.%QQ:EQW:61C
M=&QP87)<861J=7-T<FEG:'0@7&)<9C1<9G,S,EQL86YG,C`U-UQC9W)I9"!<
M<V)A<V5D;VXP(%QS;F5X=#$X($)O9'D@5&5X="`R.WU[7',Q.5QQ:EQS;#,V
M,%QS;&UU;'0P7'=I9&-T;'!A<EQA9&IU<W1R:6=H="!<9C1<9G,S,EQL86YG
M,C`U-UQC9W)I9"!<<V)A<V5D;VXP(%QS;F5X=#$Y($)O9'D@5&5X=#M]>UQS
M,C!<<6I<<VPS-C!<<VQM=6QT,%QW:61C=&QP87)<861J=7-T<FEG:'0@7&8T
M7&QA;F<R,#4W7&-G<FED(%QS8F%S961O;C`@7'-N97AT,C`@0F]D>2!497AT
M(#,[?7M<<S(Q7'%J7&9I+3<R,%QL:3<R,%QS;#,V,%QS;&UU;'0P7'=I9&-T
M;'!A<EQA9&IU<W1R:6=H="!<8EQF-%QF<S,R7&QA;F<R,#4W7&-G<FED(%QS
M8F%S961O;C`@7'-N97AT,C$@0F]D>2!497AT($EN9&5N="`R.WU[7"I<8W,R
M,B!<861D:71I=F4@7'-B87-E9&]N,3`@<&%G92!N=6UB97([?7M<<S(S7'=I
M9&-T;'!A<EQA9&IU<W1R:6=H="!<8V)P870Y(%QF,35<;&%N9S(P-3=<8V=R
M:60@7'-B87-E9&]N,"!<<VYE>'0R,R!$;V-U;65N="!-87`[?7M<<S(T7&9I
M+3(Q,C=<;&DR,3(W7'=I9&-T;'!A<EQA9&IU<W1R:6=H="!<8EQF,5QF<S(X
M7&QA;F<R,#4W7&-G<FED(%QS8F%S961O;C`@7'-N97AT,C0@0F]D>2!497AT
M($EN9&5N="`S.WU]>UPJ7&QI<W1T86)L97M<;&ES=%QL:7-T=&5M<&QA=&5I
M9"TQ7&QI<W1S:6UP;&5[7&QI<W1L979E;%QL979E;&YF8S!<;&5V96QJ8S!<
M;&5V96QF;VQL;W<P7&QE=F5L<W1A<G1A=#!<;&5V96QS<&%C93!<;&5V96QI
M;F1E;G0P>UQL979E;'1E>'1<)S`Q*CM]>UQL979E;&YU;6)E<G,[?7U[7&QI
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M.3$S(#\[?7M<;&5V96QN=6UB97)S.WU<9C-<9G,Q-EQF8FEA<S`@7&9I+3,Y
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M<F5S=&%R=%QP9VYS=&%R=',T7&QI;F5X,%QH96%D97)Y-S`Y7&9O;W1E<GDU
M-C=<8V]L<W@W,#E<96YD;FAE<F5<<V5C=&1E9F%U;'1C;"![7&9O;W1E<B!<
M<&%R9%QP;&%I;B!<<S$U7')I,S8P7'=I9&-T;'!A<EQT<6-<='@T,34S7'1Q
M<EQT>#@S,#9<<'9P87)A7'!H;7)G7'!O<WAR7'!O<WDP7&%D:G5S=')I9VAT
M(%QF-%QF<S(P7&QA;F<R,#4W7&-G<FED('M<8W,R,B`-"EQP87(@?5QP87)D
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M<&YU8VQT<EQP;G-T87)T,5QP;FEN9&5N=#<R,%QP;FAA;F=[7'!N='AT82`N
M?7U[7"I<<&YS96-L=FPS7'!N9&5C7'!N<W1A<G0Q7'!N:6YD96YT-S(P7'!N
M:&%N9WM<<&YT>'1A("Y]?7M<*EQP;G-E8VQV;#1<<&YL8VQT<EQP;G-T87)T
M,5QP;FEN9&5N=#<R,%QP;FAA;F=[7'!N='AT82`I?7U[7"I<<&YS96-L=FPU
M7'!N9&5C7'!N<W1A<G0Q7'!N:6YD96YT-S(P7'!N:&%N9WM<<&YT>'1B("A]
M>UQP;G1X=&$@*7U]>UPJ7'!N<V5C;'9L-EQP;FQC;'1R7'!N<W1A<G0Q7'!N
M:6YD96YT-S(P7'!N:&%N9WM<<&YT>'1B("A]>UQP;G1X=&$@*7U]>UPJ7'!N
M<V5C;'9L-UQP;FQC<FU<<&YS=&%R=#%<<&YI;F1E;G0W,C!<<&YH86YG>UQP
M;G1X=&(@*'U[7'!N='AT82`I?7U[7"I<<&YS96-L=FPX7'!N;&-L=')<<&YS
M=&%R=#%<<&YI;F1E;G0W,C!<<&YH86YG>UQP;G1X=&(@*'U[7'!N='AT82`I
M?7U[7"I<<&YS96-L=FPY7'!N;&-R;5QP;G-T87)T,5QP;FEN9&5N=#<R,%QP
M;FAA;F=[7'!N='AT8B`H?7M<<&YT>'1A("E]?5QP87)D7'!L86EN(%QW:61C
M=&QP87)<861J=7-T<FEG:'0@7&8Q,EQL86YG,C`U-UQC9W)I9"![7&)<9C%<
M9G,R,"`-"EQP87(@?5QP87)D(%QW:61C=&QP87)<;W5T;&EN96QE=F5L,%QA
M9&IU<W1R:6=H="![7&)<9C%<9G,R,"!486)L92`Q.EQT86(@4W5M;6%R>2!O
M9B!S;VUE($%D=F%N=&%G97,@86YD($1I<V%D=F%N=&%G97,@;V8@26UP;&EC
M:70@86YD(`T*7'!A<B!]7'!A<F0@7&QI-S(P7'=I9&-T;'!A<EQO=71L:6YE
M;&5V96PP7&%D:G5S=')I9VAT('M<8EQF,5QF<S(P($5X<&QI8VET($%P<')O
M86-H97,@=&\@2&5A;'1H($-A<F4@4')I;W)I='D@4V5T=&EN9PT*7'!A<B!]
M7'!A<F0@7'=I9&-T;'!A<EQA9&IU<W1R:6=H="![7&8Q7&9S,C`@#0I<<&%R
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M87)D(%QW:61C=&QP87)<:6YT8FQ<861J=7-T<FEG:'0@>UQB7&8Q7&9S,C`@
M#0I<<&%R(%-Y<W1E;0T*7'!A<B!<8V5L;"`-"EQP87(@061V86YT86=E<UQC
M96QL(`T*7'!A<B!$:7-A9'9A;G1A9V5S7&-E;&P@?5QP87)D(%QW:61C=&QP
M87)<:6YT8FQ<861J=7-T<FEG:'0@>UQF,5QF<S(P(%QR;W<@?5QT<F]W9"!<
M=')G87!H,3`X7'1R;&5F=#0R-EQT<FME97`@7&-L=F5R=&%L=%QC;&)R9')T
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M=')I9VAT(%QF-%QL86YG,C`U-UQC9W)I9"![7&)<9C%<9G,R,"!);7!L:6-I
M='U[7&8Q7&9S,C`@7&-E;&P@>UQP;G1E>'1<<&%R9%QP;&%I;EQI;G1B;%QF
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M86YG>UQP;G1X=&(@7"=B-WU]7&QS,5QA9&IU<W1R:6=H="![7&8Q7&9S,C`@
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M=&(@7"=B-WU]7&QS,5QA9&IU<W1R:6=H="![7&8Q7&9S,C`@4')E<V5R=F5S
M('!A=&EE;G0@=')U<W0@:6X@9&]C=&]R(&%N9"!C;VYC96%L<R!R96%L:71Y
M(&]F(')E<W1R:6-T960@96QI9VEB:6QI='D@(&9O<B!H96%L=&@@8V%R92`-
M"EQP87(@?5QP87)D(%QW:61C=&QP87)<:6YT8FQ[7"I<<&X@7'!N;'9L8V]N
M=%QI;'9L,%QL<S!<<&YR;F]T,%QP;F1E8R!]7&%D:G5S=')I9VAT('M<9C%<
M9G,R,"`-"EQP87(@#0I<<&%R(%QC96QL('M<<&YT97AT7'!A<F1<<&QA:6Y<
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M9"!B96EN9R!G=6%R9&EA;B!O9B!T:&4@<'5B;&EC('!U<G-E+B`@56YC;&5A
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M<R!I;B!C;&EN:6-A;"!P<F%C=&EC92`-"EQP87(@>UQP;G1E>'1<<&%R9%QP
M;&%I;EQI;G1B;%QF,UQF<S$V7&-G<FED(%QL;V-H7&%F,UQD8F-H7&%F,%QH
M:6-H7&8S(%PG8C=<=&%B?7U<<&%R9"!<9FDM,SDW7&QI,SDW7'=I9&-T;'!A
M<EQI;G1B;%QT>#,V,'M<*EQP;B!<<&YL=FQB;'1<:6QV;#!<;',Q7'!N<FYO
M=#!<<&YF,UQP;F9S,39<<&YS=&%R=#%<<&YI;F1E;G0S.3=<<&YH86YG>UQP
M;G1X=&(@7"=B-WU]7&QS,5QA9&IU<W1R:6=H="![7&8Q7&9S,C`@3&%C:R!O
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M-WU]7&QS,5QA9&IU<W1R:6=H="![7&8Q7&9S,C`@26YE<75I='D@9'5E('1O
M(&1I9F9E<F5N=&EA;"!P871I96YT('!O=V5R(`T*7'!A<B!]7'!A<F0@7'=I
M9&-T;'!A<EQI;G1B;'M<*EQP;B!<<&YL=FQC;VYT7&EL=FPP7&QS,%QP;G)N
M;W0P7'!N9&5C('U<861J=7-T<FEG:'0@>UQF,5QF<S(P(%QC96QL('U<<&%R
M9"!<=VED8W1L<&%R7&EN=&)L>UPJ7'!N(%QP;FQV;&-O;G1<:6QV;#!<;',P
M7'!N<FYO=#!<<&YD96,@?5QA9&IU<W1R:6=H="![7&8Q7&9S,C`@7')O=R!]
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M8V5L;'@U,3`S7&-L=F5R=&%L=%QC;&)R9')T7&)R9')S7&)R9')W,34@7&-L
M8G)D<FQ<8G)D<G-<8G)D<G<Q-2!<8VQB<F1R8EQB<F1R<UQB<F1R=S$U(%QC
M;&)R9')R7&)R9')S7&)R9')W,34@7&-L='AL<G1B(%QC96QL>[log in to unmask]<<&%R
M9"!<=VED8W1L<&%R7&EN=&)L>UPJ7'!N(%QP;FQV;&-O;G1<:6QV;#!<;',P
M7'!N<FYO=#!<<&YD96,@?5QA9&IU<W1R:6=H="![7&)<9C%<9G,R,"!%>'!L
M:6-I='U[7&8Q7&9S,C`@7&-E;&P@>UQP;G1E>'1<<&%R9%QP;&%I;EQI;G1B
M;%QF,UQF<S$V7&-G<FED(%QL;V-H7&%F,UQD8F-H7&%F,%QH:6-H7&8S(%PG
M8C=<=&%B?7U<<&%R9"!<9FDM,SDW7&QI,SDW7'=I9&-T;'!A<EQI;G1B;%QT
M>#,V,'M<*EQP;B!<<&YL=FQB;'1<:6QV;#!<;',Q7'!N<FYO=#!<<&YF,UQP
M;F9S,39<<&YS=&%R=#%<<&YI;F1E;G0S.3=<<&YH86YG>UQP;G1X=&(@7"=B
M-WU]7&QS,5QA9&IU<W1R:6=H="![7&8Q7&9S,C`@16YC;W5R86=E<R!P=6)L
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M86YG>UQP;G1X=&(@7"=B-WU]7&QS,5QA9&IU<W1R:6=H="![7&8Q7&9S,C`@
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M;G1X=&(@7"=B-WU]7&QS,5QA9&IU<W1R:6=H="![7&8Q7&9S,C`@5')A;G-P
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M9&IU<W1R:6=H="![7&8Q7&9S,C`@4&]T96YT:6%L;'D@;6]R92!E<75I=&%B
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M<W1R:6=H="![7&8Q7&9S,C`@06-C;W5N=&%B;&4-"EQP87(@>UQP;G1E>'1<
M<&%R9%QP;&%I;EQI;G1B;%QF,UQF<S$V7&-G<FED(%QL;V-H7&%F,UQD8F-H
M7&%F,%QH:6-H7&8S(%PG8C=<=&%B?7U<<&%R9"!<9FDM,SDW7&QI,SDW7'=I
M9&-T;'!A<EQI;G1B;%QT>#,V,'M<*EQP;B!<<&YL=FQB;'1<:6QV;#!<;',Q
M7'!N<FYO=#!<<&YF,UQP;F9S,39<<&YS=&%R=#%<<&YI;F1E;G0S.3=<<&YH
M86YG>UQP;G1X=&(@7"=B-WU]7&QS,5QA9&IU<W1R:6=H="![7&8Q7&9S,C`@
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M7&QS,5QA9&IU<W1R:6=H="![7&8Q7&9S,C`@1&EF9FEC=6QT('1O(&1E=F5L
M;W`@86YD(&]P97)A=&EO;F%L:7-E#0I<<&%R('M<<&YT97AT7'!A<F1<<&QA
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M7&QS,5QA9&IU<W1R:6=H="![7&8Q7&9S,C`@1&EF9FEC=6QT>2!O9B!E<W1A
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M,%QP;F1E8R!]7&%D:G5S=')I9VAT('M<9C%<9G,R,"`-"EQP87(@?5QP87)D
M(%QW:61C=&QP87)[7"I<<&X@7'!N;'9L8V]N=%QI;'9L,%QL<S!<<&YR;F]T
M,%QP;F1E8R!]7&]U=&QI;F5L979E;#!<861J=7-T<FEG:'0@>UQF,5QF<S$V
M($)A<V5D(&]N($AA9&]R;B!$+B!.871I;VYA;"!(96%L=&@@0V]M;6ET=&5E
M+"!.97<@6F5A;&%N9'U[7&8Q7&9S,C`@(`T*7'!A<B!]7'!A<F0@7'=I9&-T
M;'!A<GM<*EQP;B!<<&YL=FQC;VYT7&EL=FPP7&QS,%QP;G)N;W0P7'!N9&5C
M('U<861J=7-T<FEG:'0@>UQF,5QF<S(P(`T*7'!A<B`-"EQP87(@#0I<<&%R
M(`T*7'!A<B`-"EQP87(@?5QT<F]W9"!<=')G87!H,3`X7'1R;&5F="TQ,#@@
M7&-L=F5R=&%L=%QC;'1X;')T8B!<8V5L;[log in to unmask]&-L=F5R=&%L=%QC;'1X
M;')T8B!<8V5L;'@Y-S@Q7'!A<F0@7'=I9&-T;'!A<EQI;G1B;'M<*EQP;B!<
M<&YL=FQC;VYT7&EL=FPP7&QS,%QP;G)N;W0P7'!N9&5C('U<861J=7-T<FEG
M:'0@>UQB7&8Q7&9S,C`@5&AE($YO<G1H(%=A;&5S(%!R:6]R:71Y(%-E='1I
M;F<@1&5M;VYS=')A=&EO;B!0<F]J96-T#0I<<&%R(%QC96QL('U[7&8Q7&9S
M,C`@3F]R=&@@5V%L97,@2&5A;'1H($%U=&AO<FET>2!I<R!U;F1E<G1A:VEN
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M=V5E;B`Q.3DR(&%N9"`Q.3DV+B`@5&AE(&-R:71E<FEA('5S960@:6X@=&AE
M(&UO9&5L(&%R92!S=6UM87)I<V5D(&EN('1H92!T86)L92`R+B`-"EQP87(@
M#0I<<&%R(%1H92!P=7)P;W-E(&]F('1H92!0<FEO<FET:7-A=&EO;B!$96UO
M;G-T<F%T:6]N(%!R;VIE8W0@:7,@=&\@97-T86)L:7-H('1O('=H870@97AT
M96YT(&$@<WES=&5M871I8R!A<'!R;V%C:"!I;F-O<G!O<F%T:6YG(&5P:61E
M;6EO;&]G:6-A;"!I;F9O<FUA=&EO;BP@979I9&5N8V4@;V8@8VQI;FEC86PL
M(&%N9"!C;W-T(&5F9F5C=&EV96YE<W,L(&%N9"!T:&4@=VES:&5S(&]F(&QO
M8V%L('!E;W!L92P@8V%N(&AE;'`@:6YF;W)M('1H92!D:69F:6-U;'0@8VAO
M:6-E<R!F86-I;F<@=&AO<V4@<F5S<&]N<VEB;&4@9F]R('!R:6]R:71Y('-E
M='1I;F<@:6X@=&AE($Y(4R!I;B!.;W)T:"!786QE<RX@(%1H92!$96UO;G-T
M<F%T:6]N(%!R;VIE8W0@=VEL;"!A;'-O(&-O;G-I9&5R('1O('=H870@97AT
M96YT('-U8V@@82!M;V1E;"!C;W5L9"!H96QP(&9U='5R92!I;G1E<BUA9V5N
M8WD@<')I;W)I='D@<V5T=&EN9R!A;F0@:&5L<"!N97=L>2!E<W1A8FQI<VAE
M9"!,;V-A;"!(96%L=&@@1W)O=7!S+@T*7'!A<B!<8V5L;"!]7'!A<F0@7'=I
M9&-T;'!A<EQI;G1B;'M<*EQP;B!<<&YL=FQC;VYT7&EL=FPP7&QS,%QP;G)N
M;W0P7'!N9&5C('U<861J=7-T<FEG:'0@>UQF,5QF<S(P(%QR;W<@?5QP87)D
M(%QW:61C=&QP87)[7"I<<&X@7'!N;'9L8V]N=%QI;'9L,%QL<S!<<&YR;F]T
M,%QP;F1E8R!]7&%D:G5S=')I9VAT('M<9C%<9G,R,"`-"EQP87(@?5QP87)D
M(%QW:61C=&QP87)[7"I<<&X@7'!N;'9L8V]N=%QI;'9L,%QL<S!<<&YR;F]T
M,%QP;F1E8R!]7&]U=&QI;F5L979E;#!<861J=7-T<FEG:'0@>UQB7&8Q7&9S
M,C`@7'!A9V4@5&%B;&4@,CI<=&%B($-O;7!O;F5N=',@;V8@=&AE($=W>6YE
M9&0@2$$@4')I;W)I=&ES871I;VX@36]D96P-"EQP87(@?5QP87)D(%QW:61C
M=&QP87)[7"I<<&X@7'!N;'9L8V]N=%QI;'9L,%QL<S!<<&YR;F]T,%QP;F1E
M8R!]7&%D:G5S=')I9VAT('M<8EQF,5QF<S(P(`T*7'!A<B!]7'1R;W=D(%QT
M<F=A<&@Q,#A<=')L969T+3$P.%QT<FME97`@7&-L=F5R=&%L=%QC;&)R9')T
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M7'!N9&5C('U<861J=7-T<FEG:'0@>UQB7&8Q7&9S,C`@1F]R;75L82!C;VUP
M;VYE;G1<8V5L;"!)=&5M('1O(&)E(&UE87-U<F5D7&-E;&P@4V-O<FEN9R!S
M8V%L95QC96QL('U<<&%R9"!<=VED8W1L<&%R7&EN=&)L>UPJ7'!N(%QP;FQV
M;&-O;G1<:6QV;#!<;',P7'!N<FYO=#!<<&YD96,@?5QA9&IU<W1R:6=H="![
M7&)<9C%<9G,R,"!<<F]W('U<=')O=V0@7'1R9V%P:#$P.%QT<FQE9G0M,3`X
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M="![7&8Q7&9S,C`@,6%<8V5L;"!(;W<@;6%N>2!P96]P;&4@:&%V92!T:&4@
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M7&8Q7&9S,C`@,6)<8V5L;"!7:&%T('!R;W!O<G1I;VX@;V8@=&AE('!E;W!L
M92!A9F9E8W1E9"!A<F4@97AP96-T960@=&\@97AP97)I96YC92!T:&4@9&5S
M:7)E9"!R97-U;'1<8V5L;"`P+3%<8V5L;"!]7'!A<F0@7'=I9&-T;'!A<EQI
M;G1B;'M<*EQP;B!<<&YL=FQC;VYT7&EL=FPP7&QS,%QP;G)N;W0P7'!N9&5C
M('U<861J=7-T<FEG:'0@>UQF,5QF<S(P(%QR;W<@?5QP87)D(%QW:61C=&QP
M87)<:6YT8FQ[7"I<<&X@7'!N;'9L8V]N=%QI;'9L,%QL<S!<<&YR;F]T,%QP
M;F1E8R!]7&%D:G5S=')I9VAT('M<9C%<9G,R,"`R85QC96QL($AO=R!G<F5A
M="!I<R!T:&4@879E<F%G92!H96%L=&@@:6UP<F]V96UE;G0@97AP96-T960@
M9F]R(&5A8V@@:6YD:79I9'5A;#\@("A!('-C;W)E(&]F(#0@:6YD:6-A=&5S
M(&%V;VED:6YG(&1E871H(&]R(&=R;W-S(&AA;F1I8V%P(&EN(&%N(&]T:&5R
M=VES92!H96%L=&AY('!E<G-O;BE<8V5L;"`P+31<8V5L;"!]7'!A<F0@7'=I
M9&-T;'!A<EQI;G1B;'M<*EQP;B!<<&YL=FQC;VYT7&EL=FPP7&QS,%QP;G)N
M;W0P7'!N9&5C('U<861J=7-T<FEG:'0@>UQF,5QF<S(P(%QR;W<@?5QP87)D
M(%QW:61C=&QP87)<:6YT8FQ[7"I<<&X@7'!N;'9L8V]N=%QI;'9L,%QL<S!<
M<&YR;F]T,%QP;F1E8R!]7&%D:G5S=')I9VAT('M<9C%<9G,R,"`R8EQC96QL
M($AO=R!M=6-H(&1O97,@=&AE(&]P=&EO;B!C;VYT<FEB=71E('1O('%U86QI
M='D@;V8@;&EF92!E+F<N.@T*7'!A<B!I;7!R;W9E;65N=',@:[log in to unmask]@T*7'!A
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M7&9S,C`@<&%T:65N="!S871I<V9A8W1I;VX-"EQP87(@>UQP;G1E>'1<<&%R
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M7&8Q7&9S,C`@<&%R=&EC:7!A=&EO;B!I;B!P;&%N;FEN9PT*7'!A<B![7'!N
M=&5X=%QP87)D7'!L86EN7&EN=&)L7&8S7&9S,39<8V=R:60@7&QO8VA<868S
M7&1B8VA<868P7&AI8VA<9C,@7"=B-UQT86)]?5QP87)D(%QF:2TS.3=<;&DQ
M,3$W7'=I9&-T;'!A<EQI;G1B;'M<*EQP;B!<<&YL=FQB;'1<:6QV;#!<;',Q
M7'!N<FYO=#!<<&YF,UQP;F9S,39<<&YS=&%R=#%<<&YI;F1E;G0S.3=<<&YH
M86YG>UQP;G1X=&(@7"=B-WU]7&QS,5QA9&IU<W1R:6=H="![7&8Q7&9S,C`@
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M<FEG:'0@>UQF,5QF<S(P(#`M,B`H=&]T86PL(&YO=`T*7'!A<B!F;W(@96%C
M:"!B96YE9FET*5QC96QL('U<<&%R9"!<=VED8W1L<&%R7&EN=&)L7&%D:G5S
M=')I9VAT('M<9C%<9G,R,"!<<F]W('U<<&%R9"!<=VED8W1L<&%R7&EN=&)L
M7&%D:G5S=')I9VAT('M<9C%<9G,R,"`S85QC96QL(%=H870@:7,@=&AE(&5V
M:61E;F-E('1H870@=&AE(&]P=&EO;B!W:6QL(&-O;G1R:6)U=&4@=&\@:&5A
M;'1H(&=A:6XO:6UP<F]V96UE;G0_("`H3&%R9V4@<F%N9&]M:7-E9"!C;VYT
M<F]L;&5D('1R:6%L<R!S:&]W:6YG(&5V:61E;F-E(&]F(&)E;F5F:71S(&]R
M(&AA<FT@=V]U;&0@<V-O<F4@,R!O<B`M,R!R97-P96-T:79E;'DI7&-E;&P@
M,R!T;R`M,UQC96QL('U<<&%R9"!<=VED8W1L<&%R7&EN=&)L7&%D:G5S=')I
M9VAT('M<9C%<9G,R,"!<<F]W('U<<&%R9"!<=VED8W1L<&%R7&EN=&)L7&%D
M:G5S=')I9VAT('M<9C%<9G,R,"`S8EQC96QL($AO=R!W:6QL('=E(&MN;W<@
M=&AA="!T:&4@;W!T:6]N(&AA<R!C;VYT<FEB=71E9"`Z('%U86QI='D@;V8@
M<&QA;FYE9"!A=61I="!O<B!O=&AE<B!M;VYI=&]R:6YG('-Y<W1E;7,@;65A
M<W5R:6YG(&]U=&-O;65S7&-E;&P@,"TS7&-E;&P@?5QP87)D(%QW:61C=&QP
M87)<:6YT8FQ<861J=7-T<FEG:'0@>UQF,5QF<S(P(%QR;W<@?5QT<F]W9"!<
M=')G87!H,3`X7'1R;&5F="TQ,#A<=')K965P(%QC;'9E<G1A;'1<8VQB<F1R
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M(&UU8V@@=VEL;"!T:&4@;W!T:6]N(&-O<W0L(&5X<')E<W-E9"!I;B`Q,#`P
M=&AS(&]F('1H92!H96%L=&@@875T:&]R:71Y(&%N;G5A;"!B=61G970@*&5G
M+B"C-#`P(&UI;&QI;VX@/2`T,#`L,#`P*BHJ*2X@(%)E<V]U<F-E(&YE=71R
M86P@;W!T:6]N<R!A<F4@<V-O<F5D(&%S(*,Q+TA!(&)U9&=E="X@($-A<&ET
M86P@8VAA<F=E<R!A<F4@=7-E9"!F;W(@0V%P:71A;"!I;G9E<W1M96YT+EQC
M96QL(*-X+TA!(&%N;G5A;"!B=61G971<8V5L;"!]7'!A<F0@7'=I9&-T;'!A
M<EQI;G1B;%QA9&IU<W1R:6=H="![7&8Q7&9S,C`@7')O=R!]7'!A<F0@7'=I
M9&-T;'!A<EQA9&IU<W1R:6=H="![7&8Q7&9S,C`@#0I<<&%R('U[7&8Q7&9S
M,38@4V]U<F-E.EQT86(@(%)-($ME871I;F=E+GU[7&8Q7&9S,C`@#0I<<&%R
M(%1H92!F;W)M=6QA([log in to unmask](@("@Q82HQ8BDJ*#)A*S)B*2HH
M,V$K,V(I(&1I=FED960@8GD@*#1A+S0P,"PP,#`J*BHI+@T*7'!A<B`-"EQP
%87(@?7T`
`
end
sum -r/size 52736/28563 section (from "begin" to "end")
sum -r/size 62837/20705 entire input file
For questions, you're probably better off asking Simant
(<[log in to unmask]> who is still involved.
>>-----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.
There I can't help you; our system was designed to tell us which of the
possible development plans facing the authority offered most health for
the money.
>
--
Richard Keatinge
homepage http://www.keatinge.demon.co.uk
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|