Priorisierung in der Medizin – Verlauf und Ergebnisse der dänischen Priorisierungsdebatte
Priorisierung in der Medizin – Verlauf und Ergebnisse der dänischen Priorisierungsdebatte
复制标题
医学优先次序——丹麦优先次序辩论的过程和结果
DOI：
10.1055/s-0031-1280841
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发表时间：
2011
期刊：
影响因子：
1.1
通讯作者：
Pornak
中科院分区：
文献类型：
--
作者：
Pornak
确定医疗优先事项有助于实现保健资源的公平和透明分配。德国关于确定优先事项的讨论仍处于初级阶段，可借鉴其他国家的经验。本文旨在分析丹麦关于确定优先事项的辩论，以促进德国的讨论。研究方法主要采用文献分析法、文献分析法和专家访谈法。丹麦关于确定医疗优先事项的辩论始于1970年代，当时成立了一个政府委员会，负责评估国家一级的保健优先事项。20世纪80年代，在政治、伦理、医学和卫生经济领域出现了更广泛的辩论。这些讨论在20世纪90年代达到了高潮，当时发起了许多地方活动，这些活动总是涉及公众。丹麦的一些县试图在日常保健工作中确定优先事项。道德理事会是20世纪90年代辩论的主要参与者，并于1996年发布了关于优先事项设定的详细声明。进入新的世纪，关于确定优先事项的辩论似乎已经结束，但在2006年，技术理事会和丹麦各地区恢复了讨论。2009年，医学协会呼吁进行广泛辩论，以实现所有患者的平等。丹麦关于确定优先事项的长期辩论对保健的实际影响甚微。主要问题似乎是没有努力在国家一级将各种地方倡议捆绑在一起，以及缺乏强有力的参与者将讨论结果付诸实践。然而，今天对确定优先事项的态度主要是积极的，甚至政治家也自由地谈论它。
Priority setting in medicine helps to achieve a fair and transparent distribution of health-care resources. The German discussion about priority setting is still in its infancy and may benefit from other countries' experiences. This paper aims to analyse the Danish priority setting debate in order to stimulate the German discussion. The methods used are a literature analysis and a document analysis as well as expert interviews. The Danish debate about priority setting in medicine began in the 1970s, when a government committee was constituted to evaluate health-care priorities at the national level. In the 1980s a broader debate arose in politics, ethics, medicine and health economy. The discussions reached a climax in the 1990s, when many local activities-always involving the public-were initiated. Some Danish counties tried to implement priority setting in the daily routine of health care. The Council of Ethics was a major player in the debate of the 1990s and published a detailed statement on priority setting in 1996. With the new century the debate about priority setting seemed to have come to an end, but in 2006 the Technology Council and the Danish Regions resumed the discussion. In 2009 the Medical Association called for a broad debate in order to achieve equity among all patients. The long lasting Danish debate on priority setting has entailed only very little practical consequences on health care. The main problems seem to have been the missing effort to bundle the various local initiatives on a national level and the lack of powerful players to put results of the discussion into practice. Nevertheless, today the attitude towards priority setting is predominantly positive and even politicians talk freely about it.