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Evidenzbasierte Bestimmung des Leistungskatalogs im Gesundheitswesen? Das Beispiel des englischen National Institute for Clinical Excellence (NICE)

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  • Rothgang, Heinz
  • Niebuhr, Dea
  • Wasem, Jürgen
  • Greß, Stefan

Abstract

Das englische National Institute for Clinical Excellence (NICE) wird in der bundesdeutschen Diskussion um die Reform der Institutionen zur Konkretisierung des Leistungskatalogs in der GKV entweder als Vorbild oder als abschreckendes Beispiel genannt. Die Analyse der von NICE angewandten Verfahren und Kriterien zur Bewertung medizinischer Leistungen zeigt eine beachtliche Legitimität der Entscheidungen von NICE: Zum einen sind die von NICE angewandten Verfahren transparent und lassen eine breite Repräsentanz der beteiligten Interessengruppen zu, wodurch die Entscheidungen prozedural legitimiert werden. Zum anderen berücksichtigen die Entscheidungskriterien die Kosteneffektivität der zu bewertenden Leistungen - wenn solche Informationen zuverlässig vorliegen -, ohne dass Kosteneffektivität das einzige Entscheidungskriterium bleibt. Damit werden die Entscheidungen vom Ergebnis her legitimiert. Schematische direkte Rationierungseffekte als Folge der von NICE getroffenen Entscheidungen sind nur sehr eingeschränkt identifizierbar. Dennoch wird der Trade-Off zwischen allokativ optimalen Entscheidungen und der Vermeidung von distributiven Konsequenzen deutlich.

Suggested Citation

  • Rothgang, Heinz & Niebuhr, Dea & Wasem, Jürgen & Greß, Stefan, 2004. "Evidenzbasierte Bestimmung des Leistungskatalogs im Gesundheitswesen? Das Beispiel des englischen National Institute for Clinical Excellence (NICE)," Working papers of the ZeS 02/2004, University of Bremen, Centre for Social Policy Research (ZeS).
    • Handle: RePEc:zbw:zeswps:022004
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    References listed on IDEAS

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    1. Stephen Birch & Amiram Gafni, 2002. "On being NICE in the UK: guidelines for technology appraisal for the NHS in England and Wales," Health Economics, John Wiley & Sons, Ltd., vol. 11(3), pages 185-191, April.
    2. John Hutton & Alan Maynard, 2000. "A nice challenge for health economics," Health Economics, John Wiley & Sons, Ltd., vol. 9(2), pages 89-93, March.
    3. Niebuhr, Dea & Greß, Stefan & Rothgang, Heinz & Wasem, Jürgen, 2003. "Verfahren und Kriterien zur Konkretisierung des Leistungskatalogs in der gesetzlichen Krankenversicherung," Working papers of the ZeS 05/2003, University of Bremen, Centre for Social Policy Research (ZeS).
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    3. Louise Longworth & Martin Buxton & Mark Sculpher & David Smith, 2005. "Estimating utility data from clinical indicators for patients with stable angina," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 6(4), pages 347-353, December.

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