Priority setting in health care: Attitudes of physicians and patients

Jeannette Winkelhage, Margrit Schreier, Adele Diederich

School of Humanities and Social Sciences, Jacobs University, Bremen, Germany.

DOI: 10.4236/health.2013.54094                

Abstract

Background: The opinion of physicians clearly counts in prioritizing health care, but there is little information on the rationales underlying treatment decisions and whether these rationales are accepted by patients. Objective: To compare physicians and patients regarding their understanding and use of therapeutic benefit and treatment costs as criteria for prioritizing health care. Methods: Seven physicians and twelve patients were purposefully selected to yield a heterogeneous sample. Participants were interviewed face-to-face, following a semi-structured topic guide comprising three scenarios that focused on interventions with low or unproven therapeutic benefit and high costs, respectively. For data analysis we used qualitative content analysis. Results: We found that patients and physicians differed in their understanding of therapeutic benefit, their expectations of what medicine can do and their use of costs as criteria for prioritizing health care. Physicians were less likely to assess a certain intervention as effec tive, and they less often accepted upper funding limits in health care. Unlike the physicians, patients raised non-medical aspects in decision making such as the patient’s consent and social inequalities. Conclusions: The revealed differences point toward the necessity to strengthen the doctor-patient communication, to improve information for patients about the possibilities and limits of health care and to gain a deeper understanding of their attitudes, wishes and concerns to reach an agreement by physicians and patients on the treatment to be implemented.

Keywords

Prioritization; Patients; Physicians; Qualitative Research; Interviews; Semi-Structured; Content Analysis

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Sabik, L.M. and Lie, R.K. (2008) Priority setting in health care: Lessons from the experiences of eight countries. International Journal for Equity in Health, 7, 1-13. doi:10.1186/1475-9276-7-4
[2]	Skirbekk, H., Middelthon, A.-L., Hjortdahl, P. and Finset, A. (2011) Mandates of trust in the doctor-patient relationship. Qualitative Health Research, 21, 1182-1190. doi:10.1177/1049732311405685
[3]	Strech, D., Danis, M., Löb, M. and Marckmann, G. (2009) Ausmaß und Auswirkungen von Rationierung in deutschen Krankenhäusern—Ärztliche Einschätzungen aus einer repräsentativen Umfrage. Deutsche Medizinische Wochenschrift, 134, 1261-1266. doi:10.1055/s-0029-1225273
[4]	Diederich, A. and Schreier, M. (2010) Einstellungen zu Priorisierungen in der medizinischen Versorgung: Ergebnisse einer repräsentativen Bevölkerungsbefragung. FOR 655, 27. http://www.priorisierung-in-der-medizin.de/documents/FOR655_Nr27_Diederich_Schreier.pdf
[5]	Gallego, G., Taylor, S.J., McNeill, P. and Brien, J.A.E. (2007) Public views on priority setting for high cost medications in public hospitals in Australia. Health Expectations, 10, 224-235. doi:10.1111/j.1369-7625.2007.00439.x
[6]	Hurst, S.A., Slowther, A.-M., Forde, R., Pegoraro, R., Reiter-Theil, S., Perrier, A., Garrett-Mayer, E. and Danis, M. (2006) Prevalence and determinants of physician bedside rationing: Data from Europe. Journal of General Internal Medicine, 21, 1138-1143. doi:10.1111/j.1525-1497.2006.00551.x
[7]	Ginsburg, M.E. (2000) A survey of physician attitudes and practices concerning cost-effectiveness in patient care. The Western Journal of Medicine, 173, 390-394.
[8]	Rosén, P. and Karlberg, I. (2002) Opinions of Swedish citizens, health-care politicians, administrators and doctors on rationing and health-care financing. Health Expectations, 5, 148-155. doi:10.1046/j.1369-6513.2002.00169.x
[9]	Ryynänen, O.P., Myllykangas, M., Kinnunen, J. and Takala, J. (1999) Attitudes to health care prioritisation methods and criteria among nurses, doctors, politicians and the general public. Social Science and Medicine, 49, 1529- 1539. doi:10.1016/S0277-9536(99)00222-1
[10]	Oddsson, K. (2003) Assessing attitude towards prioritizing in healthcare in Iceland. Health Policy, 66, 135-146. doi:10.1016/s0168-8510(02)00211-7
[11]	Berney, L., Kelly, M., Doyal, L., Feder, G., Griffiths, C. and Jones, R.I. (2005) Ethical principles and the rationing of health care: A qualitative study in general practice. British Journal of General Practice, 55, 620-625.
[12]	Heil, S., Schreier, M., Winkelhage, J. and Diederich, A. (2010) Explorationsstudien zur Priorisierung medizinischer Leistungen: Kriterien und Präferenzen verschiedener Stakeholdergruppen. FOR655, 26. http://www.priorisierung-in-der-medizin.de/documents/ FOR655_Nr26_Heil.pdf
[13]	Jansen, H. (2010) The logic of qualitative survey research and its position in the field of social research methods. Forum Qualitative Sozialforschung, 11. http://www.qualitative-research.net/index.php/fqs/article/view/1450/2946
[14]	Schreier, M., Schmitz-Justen, F., Diederich, A., Lietz, P., Winkelhage, J. and Heil, S. (2008) Sampling in qualitativen Untersuchungen: Entwicklung eines Stichprobenplanes zur Erfassung von Präferenzen unterschiedlicher Stakeholdergruppen zu Fragen der Priorisierung medizinischer Leistungen. FOR655, 12. http://www.priorisierung-in-der-medizin.de/documents/FOR655_Nr12_Schreier_et_al.pdf
[15]	Patton, M.Q. (2002) Qualitative research and evaluation methods. 3rd Edition, Sage, Thousand Oaks.
[16]	UNESCO (2006) International standard classification of education—ISCED 1997. http://www.uis.unesco.org/Library/Documents/isced97-en.pdf
[17]	Frey, J. (2005) Terri Schiavo’s unstudied life. Washington Post. http://www.washingtonpost.com/wp-dyn/articles/A64459-2005Mar24.html
[18]	Bhandari, M. and Giannoudis, P.V. (2006) Evidence- based medicine: What it is and what it is not. Injury, International Journal of the Care of the Injured, 37, 302- 306. doi:10.1016/j.injury.2006.01.034
[19]	Hsieh, H.F. and Shannon, S.E. (2005) Three approaches to qualitative content analysis. Qualitative Health Research, 15, 1277-1288. doi:10.1177/1049732305276687
[20]	Skirbekk, H. and Nortvedt, P. (2011) Making a difference: A qualitative study on care and priority setting in health care. Health Care Analysis, 19, 77-88. doi:10.1007/s10728-010-0160-x
[21]	Charles, C., Gafni, A. and Whelan, T. (1997) Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango). Social Science and Medicine, 44, 681-692. doi:10.1016/S0277-9536(96)00221-3
[22]	Hurst, S.A., Forde, R., Reiter-Theil, S., Slowther, A.M., Perrier, A., Pegoraro, R. and Danis, M. (2007) Physicians’ views on resource availability and equity in four European health care systems. BMC Health Service Research, 7, 137-148. doi:10.1186/1472-6963-7-137
[23]	Stronks, K., Strijbis, A.-M., Wendte, J.F. and Gunning- Schepers, L.J. (1997) Who should decide? Qualitative analysis of panel data from public, patients, healthcare professionals, and insurers on priorities in health care. British Medical Journal, 315, 92-96. doi:10.1136/bmj.315.7100.92