Details
Translated title of the contribution | Priority setting and rationing of pharmaceuticals – an experimental analysis of discussion processes |
---|---|
Original language | German |
Pages (from-to) | 3-13 |
Number of pages | 11 |
Journal | Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen |
Volume | 125 |
Early online date | 8 Jul 2017 |
Publication status | Published - Aug 2017 |
Abstract
Background/Objective In the face of rising expenditure among statutory sickness funds in Germany it is necessary to start a discussion about priority setting in the healthcare system. For a long time this issue has been avoided in healthcare debates. As a result, normative directives are still missing, which can lead to priority setting among healthcare providers in daily healthcare practice. Prioritization can be conducted at three different levels: at the government (macro), the institutional (meso), and the patient (micro) level. Surveys about societal preferences for different criteria exist; however, specifications on their respective weighting in the situation of approval and reimbursement of pharmaceuticals (meso) are missing. For this reason, the present study analyzed the implementation and weighting of the criteria for priority setting at the meso level, taking values and experiences of the participants into account. Method Six qualitative focus groups were carried out with representatives from the fields of medicine, ethics, public health and economics. During the discussions four fictitious drugs for the treatment of different lung diseases were prioritized based on guidelines. The discussion processes were analyzed according to Bohnsack's documentary method. Results The criteria “quality of life”, “life expectancy” and “other patient-relevant outcomes” were discussed in relation to each other. The evaluation of change in patient-relevant outcomes was difficult to perform for non-medical participants. The second argument concerned the criteria “costs”, disease severity and “number of patients”. Costs were given less weight, but were often used to support other criteria. Other challenges in reaching a consensus included emerging role conflicts between profession and personal opinion, and the transfer of the discussion to a different level of decision-making. Discussion In the discussions the problem of prioritizing did not arise from different preferences for prioritization criteria, but from the weighting of the criteria. The operationalization of the criteria seemingly depends on the decision-making situation, the participants’ personal connection with the relevant disease and on the correspondence between evidence and personal experiences.
ASJC Scopus subject areas
- Medicine(all)
- Medicine (miscellaneous)
- Social Sciences(all)
- Education
- Medicine(all)
- Health Policy
Sustainable Development Goals
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In: Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen, Vol. 125, 08.2017, p. 3-13.
Research output: Contribution to journal › Article › Research › peer review
}
TY - JOUR
T1 - Priorisierung und Rationierung von Arzneimittel
T2 - eine experimentelle Analyse von Diskussionsprozessen
AU - Aumann, Ines
AU - Litzkendorf, Svenja
AU - Damm, Kathrin
AU - von der Schulenburg, J. Matthias Graf
N1 - Publisher Copyright: © 2017 Copyright: Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2017/8
Y1 - 2017/8
N2 - Background/Objective In the face of rising expenditure among statutory sickness funds in Germany it is necessary to start a discussion about priority setting in the healthcare system. For a long time this issue has been avoided in healthcare debates. As a result, normative directives are still missing, which can lead to priority setting among healthcare providers in daily healthcare practice. Prioritization can be conducted at three different levels: at the government (macro), the institutional (meso), and the patient (micro) level. Surveys about societal preferences for different criteria exist; however, specifications on their respective weighting in the situation of approval and reimbursement of pharmaceuticals (meso) are missing. For this reason, the present study analyzed the implementation and weighting of the criteria for priority setting at the meso level, taking values and experiences of the participants into account. Method Six qualitative focus groups were carried out with representatives from the fields of medicine, ethics, public health and economics. During the discussions four fictitious drugs for the treatment of different lung diseases were prioritized based on guidelines. The discussion processes were analyzed according to Bohnsack's documentary method. Results The criteria “quality of life”, “life expectancy” and “other patient-relevant outcomes” were discussed in relation to each other. The evaluation of change in patient-relevant outcomes was difficult to perform for non-medical participants. The second argument concerned the criteria “costs”, disease severity and “number of patients”. Costs were given less weight, but were often used to support other criteria. Other challenges in reaching a consensus included emerging role conflicts between profession and personal opinion, and the transfer of the discussion to a different level of decision-making. Discussion In the discussions the problem of prioritizing did not arise from different preferences for prioritization criteria, but from the weighting of the criteria. The operationalization of the criteria seemingly depends on the decision-making situation, the participants’ personal connection with the relevant disease and on the correspondence between evidence and personal experiences.
AB - Background/Objective In the face of rising expenditure among statutory sickness funds in Germany it is necessary to start a discussion about priority setting in the healthcare system. For a long time this issue has been avoided in healthcare debates. As a result, normative directives are still missing, which can lead to priority setting among healthcare providers in daily healthcare practice. Prioritization can be conducted at three different levels: at the government (macro), the institutional (meso), and the patient (micro) level. Surveys about societal preferences for different criteria exist; however, specifications on their respective weighting in the situation of approval and reimbursement of pharmaceuticals (meso) are missing. For this reason, the present study analyzed the implementation and weighting of the criteria for priority setting at the meso level, taking values and experiences of the participants into account. Method Six qualitative focus groups were carried out with representatives from the fields of medicine, ethics, public health and economics. During the discussions four fictitious drugs for the treatment of different lung diseases were prioritized based on guidelines. The discussion processes were analyzed according to Bohnsack's documentary method. Results The criteria “quality of life”, “life expectancy” and “other patient-relevant outcomes” were discussed in relation to each other. The evaluation of change in patient-relevant outcomes was difficult to perform for non-medical participants. The second argument concerned the criteria “costs”, disease severity and “number of patients”. Costs were given less weight, but were often used to support other criteria. Other challenges in reaching a consensus included emerging role conflicts between profession and personal opinion, and the transfer of the discussion to a different level of decision-making. Discussion In the discussions the problem of prioritizing did not arise from different preferences for prioritization criteria, but from the weighting of the criteria. The operationalization of the criteria seemingly depends on the decision-making situation, the participants’ personal connection with the relevant disease and on the correspondence between evidence and personal experiences.
KW - decision-making process
KW - focus groups
KW - priority setting
KW - qualitative research
KW - rationing
UR - http://www.scopus.com/inward/record.url?scp=85022058656&partnerID=8YFLogxK
U2 - 10.1016/j.zefq.2017.04.010
DO - 10.1016/j.zefq.2017.04.010
M3 - Artikel
C2 - 28694036
AN - SCOPUS:85022058656
VL - 125
SP - 3
EP - 13
JO - Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen
JF - Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen
SN - 1865-9217
ER -