[Assessment of the value of health-care services--the first step]

The average increase of health-care expenditures in OECD countries is higher than the corresponding increase in gross national products (GNPs). Therefore, it is necessary in these countries to react to this increase. Although there is agreement that rationing cannot be avoided, the optimal method has not yet been found. In order to contribute to the solution of this problem, the Institute for Quality and Economics in Health Care (IQWiG) has been established in 2004 in Germany. One of the central tasks of this institute is the development of a method to assess the value of health-care services. In this paper, general problems of the assessment of health-care value and specific problems which emerge from the presently proposed concepts for assessment of the health-care value are summarized. Based on the analysis of these problems it is tried to derive a new approach. The approach presumes that the decisions which have to be made for assessment of health-care value are rather complex and subjective. Scientific methods can increase transparency but cannot replace democratic decisions. The new approach requires the introduction of strategies like shared or democratic decision-making. The discussion of this essential strategy is the first step in the development of a consensus for assessment of the value of health care.