Wie können medizinische Leistungen priorisiert werden? Ein Modell aus Schweden

In health care there is a growing gap between what can be accomplished and financed. Priority setting in medicine helps to counteract the challenges of quality improvement, rationalisation, and as the case may be rationing adequately. This paper aims to describe a model on priority setting of medical interventions that has been worked out along with the development of health-care guidelines in Sweden. The methods used are a literature analysis and a document analysis as well as expert interviews. The model of vertical priority setting is based on the three priority setting criteria: human dignity, need and solidarity, and cost-efficiency that have been set down by a parliamentary commission from 19921995. Objects of priority setting are condition-treatment pairs. Of central importance are the severity of the condition and the benefit of the treatment as an expression of treatment need, as well as cost-efficiency. The model is characterised by a pronounced orientation towards scientific evidence. The priority ratings from 110 do not follow a standardised algorithm but can be understood as a comprehensive appraisal. The discussion focuses on the importance of the integration of the medical profession into the development of vertical priority setting guidelines.