Elsevier

Health Policy

Volume 50, Issues 1–2, December 1999, Pages 1-22
Health Policy

Priority setting in health policy in Sweden and a comparison with Norway

https://doi.org/10.1016/S0168-8510(99)00061-5Get rights and content

Abstract

The development of priority setting policies has been an important part of the national agenda for health services in Sweden and Norway during the past 10 years. Both countries have health systems with a pronounced public character and a declared emphasis on equity and solidarity. Both countries have also had National Priority Commissions that have developed general documents providing advice, but not very detailed guidelines, on how to set priorities. Resource constraints and the rapid restructuring of the health care system were important characteristics forming the background for the National Priority Commission in Sweden (1995). In Norway, the starting point for the first-ever Priority Commission in the world (1987) was how to set limits for health care in a society with rapidly increasing wealth. The second Norwegian Commission (1997) critically reviewed the effects of the general principles for priority setting that have been put forward, and demonstrated the importance to link them to steering tools within health care services.

Introduction

This paper will review priority setting policies during the past 10 years in Sweden, with brief comparisons with Norway. First, the features of both health systems and the general health policy measures that have been undertaken in recent years are introduced. This is followed by a description of the specific National Priority Commissions that were established in Norway and Sweden. Third, actual priority setting activities are discussed; and finally, the impact of the specific approaches taken by the National Priority Commissions in the two countries are evaluated. Due to the author’s nationality, the paper focuses mainly on Sweden.

Section snippets

The health systems

There are many features common to the health systems of Nordic countries. Even though historical and cultural developments within individual countries have led to differences, these are mainly marginal [1]. The Nordic systems have an overwhelmingly public character with regard to both the financing and the delivery of services. Private elements traditionally have been quite firmly integrated into the public management of the systems; for example, doctors practising ‘privately’ do so mostly

The Swedish Parliamentary Commission on Priority Setting

After several waves of public and media discussions during 1988–1991, the Swedish Parliament took the initiative and organised a public hearing focused on the issue of choices in health care. This resulted in a request to the Government to set up a Parliamentary Commission, which in Sweden is a traditional way of formally investigating an important social issue. After deliberations by Government officials, during which time there was a general election and a change in Government from a social

The new National Commission for priority setting

In order to maintain a national monitoring mechanism for priority setting, Parliament also decided to set up a new national body for priorities in health care, the National Priority Commission [6]. With a 3-year mandate, the Commission began its work in mid-1998 and has the following main functions:

  • to disseminate information on Parliament’s decision regarding priority setting;

  • to develop methods to promote implementation of the decision;

  • to monitor and evaluate the effects of the decision; and

  • to

Local developments in priority setting within Swedish County Councils

As with most other areas of health services in Sweden, the development of priority setting now occurs within the County Councils. Several County Councils have developed their own local models for priority setting. In some County Councils, the focus is on ethical committees, while in others, more independently based priority committees have the task of developing priority setting methods or increasing general discussion of the issues involved. Local implementation of priority setting schemes

Specific measures influencing priorities

As is evident from the presented information, the Swedish national priority recommendations are very general. Somewhat more detailed directives for action have been developed in certain County Councils. In some areas, national decisions influence this field, even if they are not directly linked to prioritisation. The following areas and activities are the most important:

Public involvement

In summary, so far, the Swedish health services system can be described as a system that has experienced strong economic pressures over a number of years. During the past few years, the emphasis has been on structural reforms and the reallocation of resources. The National Commission on Priorities produced guidelines of a general sort, emphasising an ethical platform and a principal list of priority groups. Implementation and development of more practical tools are left to the local level of

The Priority Commissions in Norway

Norway was the first country in the world to undertake work on the priority setting issue though a National Priority Commission. As early as 1985, a National Parliamentary Commission was set up with the task to analyse and propose guidelines for national and local health policy priorities. The commission was composed of health care experts as well as members of the public; but unlike Sweden, no politicians were included. The commission was chaired by the former rector of the University of Oslo,

Sweden and Norway — some comparative aspects of priority setting

Although Sweden and Norway are quite similar to each other with regard to many aspects of their governing styles and tradition, as well as in the structure of their health care systems, there are several, interesting differences in their handling of priority setting. Norway established a National Commission on Priority Setting very early on. It is worth noting that in Norway, the discussion on priority setting was triggered, paradoxically, by a situation where limits on health care had to be

References (21)

There are more references available in the full text version of this article.

Cited by (43)

  • A new proposal for priority setting in Norway: Open and fair

    2016, Health Policy
    Citation Excerpt :

    This is true across all payer systems and for rich and poor countries alike [1,2]. To manage increasing demands is a challenge also for Norway, despite being one of the richest countries in the world and having a long tradition of systematic priority setting at the national level [3]. In response, the third Norwegian Committee on Priority Setting in the Health Sector recently laid out a new, comprehensive framework for setting priorities.

  • Balancing adequacy and affordability?: Essential Health Benefits under the Affordable Care Act

    2014, Health Policy
    Citation Excerpt :

    Hence, the situation differs markedly from other developed nations like New Zealand, Israel, the United Kingdom and the Netherlands, which have specifically worked to establish and implement frameworks to set healthcare priorities [10,25,13,26]. Particularly Nordic countries like Sweden and Norway have developed, and to a more limited degree applied, underlying principles to guide healthcare decisionmaking [10]. In addition, recent reforms in Germany, another federalist country like the United States, have tasked the Federal Joint Committee (FJC), with the support of the Institute for Quality and Efficiency, to define benefit packages through a deliberative process, infused with expertise and public participation [8,7,43].

  • Disease management index of potential years of life lost as a tool for setting priorities in national disease control using OECD health data

    2014, Health Policy
    Citation Excerpt :

    Drug-use disorders and alcohol-use disorders in Austria; dementia in Canada; alcohol-use disorders in France and Germany; influenza in Japan; and stomach cancer, intentional self-harm, liver cancer, and Parkinson's disease in Korea were all classified as severe DMI, based on YPLL (Supplementary Tables 6 and 7 show classification by ICD category and diagnoses in OECD countries with low DMI, respectively). In many countries, trials to develop priority-setting policies through a variety methods have been conducted (e.g., comparisons with neighbors [20], analyses by levels [21], and opinions in practice [22]). In this study, we tried to develop a simple method for evaluation and comparison.

  • Health technology prioritization: Which criteria for prioritizing new technologies and what are their relative weights?

    2011, Health Policy
    Citation Excerpt :

    As the main purpose of including the conjoint survey in our study was to demonstrate the methodology, we administered it to a convenience sample from Israel and Canada recruited through our professional networks. Our search found relevant literature for these 11 countries: Australia [19], Canada [20–23], Denmark [1,2,24], Finland [25,26], France [27], Israel [28], New Zealand (NZ) [23,29], Norway [1,2,23,26], Sweden [1,2,23,26,30], The Netherlands [1,2,23,26], and The United Kingdom [2,23,26,31]; and also for the US state of Oregon [32]. As summarized in Table 1, the criteria for prioritizing technologies used by each of these countries and Oregon can be sorted into three main groups: (a) Need, appropriateness and clinical benefits; (b) Efficiency; and (c) Equality, solidarity and other ethical or social values.

View all citing articles on Scopus
View full text