ABSTRACT
Age and lifestyle have generally been ruled out as criteria in setting priorities, but they may be considered by clinicians when assessing outcome. The stakeholders, especially other agencies and co-purchasers, have a very direct interest in the choice of priorities by the commission and have increasing influence over the extent to which its decisions may be implemented. Provider wishes can influence priorities in the development of health strategies as well as in the fixing of contracts. Through the development of clinical guidelines, they can also help to identify beneficial procedures. They, too, form an important stakeholder group and were consulted in the questionnaire survey. Efforts are being made everywhere to shift resources to the chronic sick and vulnerable groups as well as to prevention and community care. The many perverse incentives of the managed market in health care present a formidable challenge.
