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]
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