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Gesundheitsökonomie & Qualitätsmanagement 2006; 11(5): 302-310
DOI: 10.1055/s-2006-926697
Originalarbeit

© Georg Thieme Verlag KG Stuttgart · New York

Ressourcenallokation im Spannungsverhältnis zwischen optimalem Schwellenwert und optimalem Budget: Ansätze zur Sichtbarmachung und Herleitung eines Kosteneffektivitätsschwellenwerts

Resource Allocation between the Optimal Threshold Value and Budget: Methods for Developing a Cost-Effectiveness Threshold ValueA. Schumann1 , O. Schöffski2
  • 1Institut für Betriebswirtschaftslehre des öffentlichen Bereichs und Gesundheitswesens, Universität der Bundeswehr München
  • 2Lehrstuhl für Gesundheitsmanagement, Friedrich-Alexander-Universität Erlangen-Nürnberg
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Publication History

Publication Date:
09 October 2006 (online)

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Zusammenfassung

Da finanzielle Mittel in ihrer Höhe nur begrenzt zur Verfügung stehen, muss sich die Gesellschaft der Herausforderung stellen, eine gerechte und effektive sowie effiziente Gesundheitsversorgung anzubieten. Nur was der Gesellschaft einen Nutzen stiftet und was sie sich leisten kann, sollte nach herrschender Meinung im Rahmen einer solidarisch finanzierten Gesundheitsversorgung angeboten werden. Zielsetzung: Wenngleich eine stetige Reifung der Methodiken gesundheitsökonomischer Evaluationen festzustellen ist, bleibt bislang aber unklar, ab welchem Wert eine medizinische Maßnahme als kosteneffektiv gilt und solidarisch finanziert werden sollte. Vor diesem Hintergrund wird in diesem Beitrag das Kosteneffektivitätsschwellenwertkonzept erörtert. Methodik: Um der Beantwortung der Frage, was ein zusätzliches Lebensjahr oder qualitätskorrigiertes Lebensjahr (QALY) wert ist, nachgehen zu können, werden sechs verschiedene Ansätze zur Herleitung eines Kosteneffektivitätsschwellenwerts erläutert und diskutiert. Ergebnisse: Von diesen sechs Konzepten sind der Schattenpreisansatz und der Opportunitätskostenansatz als Ansätze zu verstehen, welchen eine explizite Budgetbeschränkung zugrunde liegt und welche die Definition eines optimalen Schwellenwerts zulassen. Für die verbleibenden vier Konzepte - Faustregeln, Vergleichskonzept, retrospektive Analyse sowie WTP-Ansatz - ist es typisch, dass diese Ansätze einen pseudooptimalen, also willkürlichen Schwellenwert liefern. Schlussfolgerung: Das Schattenpreiskonzept ist die evidenteste Methode, bei einem gegebenen Budget den medizinischen Nutzen zu maximieren. In diesem Zusammenhang ist im Interesse einer gerechten und effizienten Ressourcenallokation, eine Hinwendung von einer impliziten zu einer expliziten Rationierung zu fordern.

Abstract

Since modern healthcare systems are increasingly faced with financial restrictions and limitations, it is crucial to develop new approaches for ensuring equity, effectiveness and efficiency within the system. It is generally agreed that, in the scope of publicly funded healthcare, only services that are affordable and that will considerably benefit society should be offered. Objective: Although evalution methods in the field of healthcare economics are constantly progressing, the value at which a specific medical procedure can be considered cost-effective, and, therefore, should be publicly funded, still remains uncertain. With this as background, the cost-effectiveness threshold value concept will be discussed in this article. Methodology: In order to determine the value of a life year gained (LYG) or quality-adjusted life year (QALY), six different approaches to defining the cost-effectiveness threshold value will be introduced and discussed. Results: Two of these six approaches, the shadow-price concept and opportunity-cost concept, are based upon explicit budget constraints and permit the definition of an optimal threshold value. In contrast, the other four concepts - rule of thumb, comparison concept, retrospective analysis and the willingness-to-pay (WTP) approach - typically generate arbitrary pseudo-optimal thresholds. Conclusion: The shadow-price concept is the most evident method, given a fixed budget, to maximize the medical benefit. In this context, it appears that, in the interest of equitable and efficient resource allocation, a shift from implicit to explicit rationing is necessary.

Schlüsselwörter

Ressourcenallokation - Schwellenwert - Kosteneffektivitätsschwellenwert - Schattenpreiskonzept - Budgetbeschränkung

Key words

resource allocation - threshold value - cost-effectiveness threshold value - shadow-price concept - budget constraints

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Prof. Dr. Oliver Schöffski, MPH

Lehrstuhl für Betriebswirtschaftslehre, insbesondere Gesundheitsmanagement, Fakultät für Wirtschafts- und Sozialwissenschaften, Friedrich-Alexander-Universität Erlangen-Nürnberg

Lange Gasse 20

90403 Nürnberg

Email: oliver.schoeffski@wiso.uni-erlangen.de