Health Council of the Netherlands Reports 2003 - Gezondheidsraad

category of services will have various elements that require careful discussion
and evaluation. Examples are: the need to differentiate between the concepts of
health and disease, and the multidimensional nature of burden of disease and its
reduction (effectiveness). Other considerations of a societal, legal or ethical
nature also need to be included in the evaluation. Decision-making can only
partly be based on scientific principles, since societal views also have a role to
play. This is illustrated by the question of where one should place a threshold in
relation to burden of disease. Moreover, at what point do the costs of a service
become unacceptably high compared with its benefits? According to the
Committee, the establishment of these limit values or thresholds is a task for
government, which then requests the administrators of the national assessment
framework to assess services in the light of these limit values for burden of
disease or efficiency. The Committee recommends that a national assessment
framework should be established, taking advantage of the experiences that have
now been gathered in the UK with the National Institute for Clinical Excellence
(NICE).
Research recommendations
Further research is needed before the basic package can be formulated entirely in
the manner that has been proposed above.
First of all, the criteria for solidarity and compulsory insurance will need to
be even more clearly operationalized in relation to a number of points.
Second, more research is required in cases where data on individual disease
burden or cost-effectiveness are either missing or incomplete. This is particularly
important in the case of services that are associated with a large total disease
burden and a correspondingly great demand for care among the population,
whereas cost-effectiveness is still insufficient or else unknown.
Third, there is a need for research that contributes to effective decisionmaking
on rationing issues.
Finally, further research is needed into means of promoting efficient practices
among caregivers.
24 Health Council of the Netherlands; Reports 2003