Social values and health priority setting in Germany.

PURPOSE: The purpose of this paper is to provide an overview of health priority setting structures in Germany. It reflects on how and which social values may influence decision making, and in particular investigates the role of the Institute for Quality and Efficiency in Health Care (IQWiG) in integrating evidence-based decision making into the German system. DESIGN/METHODOLOGY/APPROACH: The paper applies Clark and Weale's framework of analysis for Social Values and Health Priority Setting to the German context. Placing German health care decision making into Clark and Weale's framework allows for an analysis of the role and content of social values in different dimensions of decision making.
FINDINGS: Germany has witnessed significant changes in its health care decision-making procedures in recent decades. The establishment of the Institute of Quality and Efficiency in Health Care (IQWiG) represents an effort to introduce health technology assessment (HTA) as a formal element of decision making in health care. In doing so, Germany has made unique methodological and structural choices that reflect the social values and institutional traditions that underpin its self-governing statutory health insurance (SHI) system. The empirical evidence suggests that the principle of solidarity is upheld as a core value in health priority setting in Germany. ORIGINALITY/VALUE: The German case of health priority setting highlights some of the challenges involved when introducing centralised HTA structures to a self-governing SHI system. As such, this paper contributes to an understanding of the different forms that HTA can take, what social values they embody and how they can affect health priority setting in different ways.