Priorisierung und Rationierung von Arzneimittel

eine experimentelle Analyse von Diskussionsprozessen

authored by

Ines Aumann, Svenja Litzkendorf, Kathrin Damm, J. Matthias Graf von der Schulenburg

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.

Organisation(s)

Institute of Health Economics

Type

Article

Journal

Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen

Volume

125

Pages

3-13

No. of pages

11

ISSN

1865-9217

Publication date

08.2017

Publication status

Published

Peer reviewed

Yes

ASJC Scopus subject areas

Medicine (miscellaneous), Education, Health Policy

Sustainable Development Goals

SDG 3 - Good Health and Well-being

Electronic version(s)

https://doi.org/10.1016/j.zefq.2017.04.010 (Access: Closed)