[Health Council recommendation on the 'Contours of the basic package']

As part of the planned reform of the health insurance system, the Minister of Health, Welfare and Sport has requested the Health Council to 'formulate an opinion with regard to the workable, scientifically-based criteria for identifying which health-care services should be included in a basic package'. The Committee on Contours of the Basic Health Benefit Package has now designated two sets of criteria distinguishing a 'solidarity package' from compulsory insurance. The individual 'burden of disease' combined with 'cost-effectiveness' forms a good basis upon which to define a basic package that, in accordance with the principle of solidarity (rich with poor, young with old, and healthy with sick), will be accessible to all. These criteria have, in the meantime, been applied in a number of situations. For a compulsory package, additional criteria are required: the costs of treatment, nursing or care; the extent to which the disorder that is to be prevented or treated may afflict other people; the preventive nature of services; and the impact that the use of services has on the efficiency of health care as a whole. The two sets of criteria may result in a single basic package, but a 'solidarity package' and a 'compulsory package' need not necessarily coincide. Considerations such as actuarial feasibility may have a bearing on the governmental decisions in this matter. In order to apply the criteria to different services, it is necessary to have a 'national assessment framework' that supports rational decisions. This framework will need to accommodate procedures for defining the package, since application of the criteria will always require a qualified approach.