Education And Debate

For Debate: Setting priorities: can Britain learn from Sweden?

BMJ 1996; 312 doi: (Published 16 March 1996) Cite this as: BMJ 1996;312:691
  1. Martin McKee, reader in public healtha,
  2. Josep Figueras, lecturer in health services managementa
  1. a Health Services Research Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  1. Correspondence to: Dr McKee.
  • Accepted 12 January 1996

The Swedish government recently published a report on priorities in health care. It was written by a cross party group of politicians and drew extensively on the views of the public, health professionals, experience of earlier local exercises in priority setting, and research based evidence. It laid down an ethical framework for approaching issues of health care rationing. Underpinning the framework are the principles of human dignity, need and solidarity, and cost efficiency. The Swedish approach thus contrasts with the British experience of many local initiatives but an absence of national political guidance. The absence of political consensus on many aspects of social policy in the United Kingdom is a major obstacle to developing an agreed ethical framework within which decision makers in the National Health Service can work.

Throughout the industrialised world there is concern about the apparent mismatch between demand for health care and the resources that governments are prepared to commit to meet it. The reasons are complex, the effects vary between nations, and most of the reasons are poorly understood, although they include the effects of aging populations, the introduction of new technology, and rising public expectations. The responses by countries have also varied widely, depending on factors such as the relative power of governments, the medical profession, insurance companies, and national pharmaceutical industries.

Five possible approaches to the mismatch between demands and resources exist: increasing resources either from government revenues or from individuals; controlling either demand (through cost sharing) or supply of services; withdrawing funding from services that are ineffective or where there is a cheaper alternative; increasing the efficiency of service provision; or creating a mechanism explicitly to identify health care priorities.1 With the possible exception of controls on supply, using capital and manpower ceilings or global budgets, as in the United Kingdom …

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