[How can priorities be set in medical services? A Swedish model]

In health care there is a growing gap between what can be accomplished and financed. Priority setting in medicine helps to counteract the challenges of quality improvement, rationalisation, and - as the case may be - rationing adequately. This paper aims to describe a model on priority setting of medical interventions that has been worked out along with the development of health-care guidelines in Sweden. The methods used are a literature analysis and a document analysis as well as expert interviews. The model of vertical priority setting is based on the three priority setting criteria: human dignity, need and solidarity, and cost-efficiency that have been set down by a parliamentary commission from 1992-1995. Objects of priority setting are condition-treatment pairs. Of central importance are the severity of the condition and the benefit of the treatment as an expression of treatment need, as well as cost-efficiency. The model is characterised by a pronounced orientation towards scientific evidence. The priority ratings from 1-10 do not follow a standardised algorithm but can be understood as a comprehensive appraisal. The discussion focuses on the importance of the integration of the medical profession into the development of vertical priority setting guidelines.