Education And Debate

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BMJ 1998; 317 doi: (Published 10 October 1998) Cite this as: BMJ 1998;317:1000

The second phase of priority setting

Editorial by Klein

This article was presented at the second international conference on priorities in health care in London on 8-10 October 1998

This week sees the second international conference on priorities in health care in London. To mark the occasion we are publishing three of the papers that will be presented at the conference. Each illustrates, in a different way, how thinking about priority setting in health care has developed over the past few years. No longer is the search for a rational set of decision making rules thought adequate: the process is seen to be more complex.

Goodbye to the simple solutions: the second phase of priority setting in health care

  1. S⊘ren Holm, senior research fellow
  1. Department of Medical Philosophy and Clinical Theory, University of Copenhagen, DK-2200 Copenhagen N, Denmark
  2. Center for Ethics in Managed Care, Harvard Pilgrim Health Care and Harvard Medical School, Boston, MA 02215, USA
  3. aHebrew University-Hadassah School of Public Health,Jerusalem91120, Israel,
  4. bHadassah Medical Organisation, Jerusalem 91120,
  5. cUnit for Health Rights and Ethics, Gertner Health Policy Institute, Tel Hashomer 52621, Israel,
  6. dDepartment of Epidemiology, Ben Gurion University, Beer Sheva 84105, Israel

    A picture of a famous statue of a small angry boy in Frognerparken in Oslo adorns the cover of the second Norwegian report on priority setting in health care, published in 1997 (figure).1 It is not evident what has made him angry, but maybe he is a youthful politician who is angry because yet another report has claimed that questions about priorities have no easy solutions and somebody dares to speak the word rationing. Or he may be a junior healthcare economist stamping his foot because the QALY has been maligned yet again. Or he may be a citizen unable to understand that an affluent society cannot give sufficient health care to all those in need. All these reactions could easily be caused by the Norwegian report1—and by the report from the Danish Council of Ethics in late 19962 and several less official interventions in the Scandinavian debates about priority setting in health care in the late 1990s.

    Crying Boy by Gustav Vigeland, 1926-33

    These debates are characterised by mounting disenchantment with simple solutions to the problems and by a shift in emphasis from the product of priority setting to the process of priority setting. In this …

    Correspondence to: Dr Chinitz

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