Many health systems around the world share a principle called ‘comprehensiveness’. In general terms this principle means that health care systems should provide the necessary health services to the population they served in order to avoid negative health consequences. It is a good principle. A health systems should be comprehensive but, the question is how. How should a health system or the people within a health system decide what services to provide? How to translate the concept of comprehensiveness to a specific policy process that defines, according to specific criteria, a list of health services that are going to be (publicly or privately) available?
This issue was brought up in our journal clubs. In one of the reading, Charles et
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In this commentary I will reflect on what are the different criteria taken into consideration by decision-makers when making coverage decisions about services or health technologies1. I will make two points: the first one is that the classical quantitative evidence about efficacy, effectiveness, safety and efficiency is necessary but not sufficient to make coverage decision. The second one is that decision-makers should be transparent about the standards they used to decided how good would be good enough to qualify for coverage (i.e., any measure of effectiveness should be compare with something to determine that is worth, how effective is effective enough).
On March 10, 2011 the following story hit the different Toronto news media, the headline and some of the comments on the web CTV news web page said something like this:
Cancer victim shouldn't have to fight for drug: NDP
[...]Paying for a breast cancer drug for a Toronto woman with a small tumour would be unfair to people in similar circumstances who don't get their stories in the media, Health Minister Deb Matthews said Thursday.
"We cannot have a health system where the stories that land on the front page of the paper determine our health care policy," Matthews said in the Ontario legislature. "We must rely on the evidence.
"It would be unfair to those who do not get their stories on the front page if we were to give priority to those