Norway의 보건의료서비스 우선순위 결정
Health Priority Setting in Norway
In comparison to Western countries where health priority setting has been dealt as an important agenda of health policy for the last two decades, little study has been conducted concerning this matter in Korea. In the near future, since health priority setting will become a hot issue of health policy in Korea, it is necessary to conduct studies on foreign cases concerning health priority setting. Against this background, this paper reviews the development of priority setting policies which has been an important part of the national agenda for health services in Norway. In addition, the impact of the specific approaches taken by the National Priority Commissions in Norway is evaluated and some key issues are noted for further policy debate. Norway was the first country in the world to undertake work on priority setting issue through a National Priority Commission (known as L?ning Ⅰ), which operated between 1985 and 1987. The policy recommendations of L?ning Ⅰ report were officially adopted in 1989 as part of the National Health Plan. But for several years limited attempts were made to implement the priorities. The recommendations of L?ning Ⅰ report seem to have been intended to provide only a guide to allocating resources at the planning level not as a way of making clinical decisions in individual cases. Therefore, a second commission(L?ning Ⅱ) was set up to evaluate the implementation of the first Commission"s recommendations and to consider techniques for formulating priorities and published its report(L?ning Ⅱ report) in 1997. The L?ning Ⅱ report reaches very sceptical conclusions concerning the possibility of devising rational priority-setting systems which can directly legitimize the priority decisions. Reliance on technical solutions based on scientific reasoning will remain inadequate if not placed within the context of political procedures. In addition, the L?ning Ⅱ report recommends a fundamental revision of setting priorities. Instead of top-down system with one overarching definition of necessary treatment and care, a bottom-up system is recommended based on specialty-specific working groups. Experience from Norway shows that a combination of guiding principles, fair procedures and appropriate medical judgements can secure the necessary legitimacy of the decisions made.
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