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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] > %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%