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The European Journal of Health Economics

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Open Access 01-02-2013 | Original Paper

Balancing equity and efficiency in the Dutch basic benefits package using the principle of proportional shortfall

Authors: E. J. van de Wetering, E. A. Stolk, N. J. A. van Exel, W. B. F. Brouwer

Published in: The European Journal of Health Economics | Issue 1/2013

Abstract

Economic evaluations are increasingly used to inform decisions regarding the allocation of scarce health care resources. To systematically incorporate societal preferences into these evaluations, quality-adjusted life year gains could be weighted according to some equity principle, the most suitable of which is a matter of frequent debate. While many countries still struggle with equity concerns for priority setting in health care, the Netherlands has reached a broad consensus to use the concept of proportional shortfall. Our study evaluates the concept and its support in the Dutch health care context. We discuss arguments in the Netherlands for using proportional shortfall and difficulties in transitioning from principle to practice. In doing so, we address universal issues leading to a systematic consideration of equity concerns for priority setting in health care. The article thus has relevance to all countries struggling with the formalization of equity concerns for priority setting.

Asserting that a disease has a low necessity of treatment is in itself difficult. A relatively small health loss may be due to something severe during a small period of time or something relatively mild but chronic. Such profiles may be evaluated differently, as discussed later in the text.

Obviously, this also depends on whether one wishes to consider societal preferences to be a good guide for normative choices.

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Title: Balancing equity and efficiency in the Dutch basic benefits package using the principle of proportional shortfall
Authors: E. J. van de Wetering
E. A. Stolk
N. J. A. van Exel
W. B. F. Brouwer
Publication date: 01-02-2013
Publisher: Springer-Verlag
Published in: The European Journal of Health Economics / Issue 1/2013
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI: https://doi.org/10.1007/s10198-011-0346-7

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Balancing equity and efficiency in the Dutch basic benefits package using the principle of proportional shortfall

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