Health targets as a means of a rational health policy in North Rhine-Westphalia.

NORTH Rhine-Westphalia (Germany); GERMANY

In 1995 the State Health Conference of North-Rhine-Westphalia (NRW) agreed ten priority health targets for NRW. The target setting process in NRW has to be seen as part of the established system of health conferences (at Länder and local level), target setting and health monitoring activities. In Germany, with its pluralistic self-governed health system, the Länder have the responsibility of coordinating the health system, at the regional/Länder level, mainly by implementing federal law, particularly the federal law on social welfare/health insurance companies. In order to improve the efficiency and effectiveness of this coordination process and actively involve all those parties who play an important role in the German health system the NRW State Health Conference was founded by the State Ministry for Health NRW in 1991. Since then, the State Health Conference with its planning board has brought about a new culture of communication and coordination in NRW. It has passed numerous joint resolutions with concrete recommendations for the various partners in health topics of principle importance. Most important is that all partners commit themselves to implementation. In 1995 a mirror process was initiated as a pilot project at the local level. Meanwhile health conferences at state and local level have been firmly established in the new NRW law on public health, initiating corresponding processes at the local level also. The ten NRW health targets passed in 1995 are closely related to the WHO HFA Strategy, covering all five areas. The concept of the ten targets included a process of further concretion and quantification. The task was given to a working group of the State Health Conference. Special consideration was given to the monitoring process and a concept for monitoring was developed. The experience with the health target process so far, being part of a comprehensive health policy discussion process in NRW, particularly shows that the agreement of targets and the target setting process is an important development instrument which may be as important as the targets themselves. More rationality, more transparency for the patients, more evaluation and outcome orientation and better prerequisites for evidence-based quality management are positive benefits of the target setting process. Of course necessary prerequisites have to be carefully kept in mind. The systematic involvement of the partners, a realistic and pragmatic approach, clear assignment of responsibilites, the clarification of resources and the possibility of reviewing the results are among the most important ones. [ABSTRACT FROM AUTHOR]