International experiences with priority setting in healthcare

Excerpt

For several reasons the problems of priority setting in healthcare are most likely not going to be solved anytime soon. First, in many countries demographic changes are leading to an increased average age of the population. Since most financial resources for healthcare are used in the final years of life, healthcare expenditures tend to rise with changing demographics. This trend is already reflected in the growing healthcare budgets of western countries. In addition, the discrepancy between available means and costs is worsening since a smaller percentage of the inhabitants have to pay a bigger bill for health care. Second, supply and demand in healthcare seem to be interconnected by positive feedback loops. Supply has grown as medical R&D has truly globalized in the last few decades. As a result novel medical technologies and pharmaceutical products are being developed at an ever accelerating pace. In addition, the interest in medical enhancement products demonstrates that the demand for healthcare products and services is almost unbounded. This may elicit a huge further scaling-up of the medical market leading to soaring costs. Third, the problem of identifying and justifying fair distributions of benefits and burdens in healthcare is exceedingly intricate. Theoretically, it is complex as there are several different theories of justice (for example, egalitarianism, utilitarianism and libertarianism) that seem to be applicable and are being applied to the problem of choices in healthcare by foremost scholars leading to very different distributive results. In addition, the problem of advancing fair distributions is difficult from a practical point of view as well as there are different levels of distribution (macro, meso and micro), each with different agents and stakeholders. Fourth, prioritization is not a dossier that is popular amongst politicians. Quite to the contrary, engagement with it seems to be widely perceived as a political career risk. So the national policy makers, who would be the obvious agents to deal with the problem in a transparent and democratically controlled manner, are usually not actively pursuing solutions as effectively as would be desirable. As none of the above mentioned factors is likely to disappear or substantially change, prioritization in healthcare will remain problematic. …