ABSTRACT
Oregon has led the way in priority setting with the most comprehensive model yet devised. Oregon was forced to rule out quality of life considerations because they violated federal law which protected the rights of disabled persons. The Oregon model may be closely followed in the Netherlands if the final package there is not unduly influenced by political considerations. In Sweden, action has been left to local initiative and a diversity of methods are employed, although the Government has recommended some priority setting principles. As in Sweden, local health authorities have been responsible for their own priority setting. Needs assessment has progressed furthest in the UK, relying mainly on epidemiological studies conducted by medical directors of public health. In Sweden and the UK, a major effort is being made to shift services from hospitals to the community. New Zealand's policy makers hope to develop a more satisfactory way of shifting resources across healthcare as a whole.
