Prioritizing Health Care Tensions and Interplay between Legal, Political, Economic and Professional Perspectives

Prioritization and distribution of healthcare services represent multiple challenges to welfare systems. In this project we have conducted empirical and normative analyzes of how healthcare prioritization is influenced by, and should be shaped by respectively legal, political, economic, administrative and professional means. The project has been organized into three modules. One module has been devoted to legal and social science analyzes of the legal sources and framework regulating access to and distribution of specialist health care services and empirical analyzes of how different actors interpret and apply the legal regulation. Another module has covered several empirical analyzes of the instruments influencing clinical life especially in the specialist health service. In addition, the decision-making process of the previous Norwegian Priority Council has been analyzed and a number of normative analyzes have been carried out, with particular reference to how to ensure fair distribution of health services and prevent socially conditioned inequality in health. The third module has arranged for an assembly of how the various regulating instruments work together in practice when the goal is to ensure fair distribution. A wide range of expertise and diciplines such as law and human rights, philosophy, political science, sociology, anthropology, health economics and medicine have been involved in this work. We will highlight the following findings from the project. There is a general tendency to juridification of the healthcare sector with a significant feature of individual rights. The way in which the content of the rights are formulated differs between different countries. Regarding the right to healthcare in Denmark, larger parts of the legal development is left to medical practice, while the Norwegian law is characterized by more detailed legal regulation. However, the legal regulation in both countries is formulated in a way that gives considerable space for political governance of how health care should be prioritized. An analysis of the implementation of the Directive on patient`s rights on cross-border health care in Norway shows that this has led to a stronger ?marketization? and less room for national prioritization within the specialist health services in Norway. A survey conducted among doctors shows that the legal regulation and the medical professional discretion is not very much in conflict with each other in the specialist health service. On the other hand the doctors often perceive that organizational conditions, reporting requirements and financial incentive systems have a negative impact on quality and equal treatment in service. In-depth interviews with health professionals in the specialist health service show that they sometimes come in a squeeze between conflicting demands. These challenges were in some cases linked to some of the regulating instruments, but far from always. A study of the recommendations of the previous Norwegian Priority Council concludes that the Council refers to the criteria given by the public authorities, but the criteria were not applied systematically or consistently. Several philosophical, normative analyzes relevant to the priority field have been conducted. These include the operationalization of the term "equal access", discussion of the relationship between social inequality in health and citizenship within the framework of professionalism, discretionary power and legal regulations and whether equal treatment in health services can be promoted by processes of juridification. The project's module-crossing book project focus on the content, purpose and interaction of various regulating instruments as well as other factors that affect the priorities that take place in the healthcare sector. The research results from this project may contribute to better governance in line with the overall objectives that the Norwegian population should have equal access to quality healthcare.

Prioritization and distribution of healthcare services represent multiple challenges to welfare systems. This study uses multidisciplinary and empirically grounded analysis of how prioritization and distribution of healthcare services is regulated, and ex plores the regulation of prioritization of healthcare services by means of legal, political, economic, administrative and professional instruments. What is the specific content and purpose of the different instruments regulating distribution and prioritiz ation of healthcare services? Do they produce similar interpretations of relevant concerns, clinical outcomes and coherent concepts of fairness? To make comparisons possible, the researchers focus on cardiovascular medicine with a particular attention on the distributive impact on elderly and socioeconomic disadvantaged patients: Module 1) Legal analysis of the legal sources and framework regulating access to and distribution of specialist healthcare services, including cardiovascular examinations and t reatment, and empirical analyses of how different actors interpret and apply the legal regulation. Module 2) Empirical and normative investigation of political, bureaucratic and professional instruments in general and in the particular field of cardiov ascular medicine. Module 3) Comparison and integrated analysis of how the various regulating instruments interplay with each other and function as a whole, and how they facilitate fairness in healthcare prioritization and distribution. The consortium pa rtners and the international board represent a broad range of expertise and disciplines (law and human rights, philosophy, political science, anthropology and medicine). Methodology from law, social sciences, health economics and philosophy will be utiliz ed, and the project will benefit from empirical as well as normative approaches and analytical frameworks.