Abstract
PurposeThe purpose of this paper is to explore Croatian views about issues regarding bedside rationing decisions.Design/methodology/approachAn online questionnaire was used to collect data from a sample of 243 Croatian citizens. In a context of hypothetical scenarios involving priority setting decisions taking by physicians, the present study elicits Croatian respondents’ views concerning: the ethical principles that should guide patients prioritization; the parties that should make prioritization decisions; and the likelihood of healthcare rationing becoming a reality. Descriptive analysis, factor analysis and parametric and non-parametric tests were performed.FindingsFindings suggest that Croatian respondents: support multiple substantive rationing criteria, with an incident in favoring the worst-off, reducing inequalities in health, translated in the fair-innings argument and efficiency achievement; appoint health professionals as rationing decision makers; and do not seem to believe in the possibility of patient selection becoming a reality.Practical implicationsFavoring the worst-off, equalizing life time health and the pursuit of efficiency seem to be the criteria most preferred by Croatian respondents to guide rationing policy at the micro level.Originality/valueThis study is the first attempt to elicit Croatian opinions concerning several rationing criteria inherent in healthcare micro allocation decisions. Healthcare rationing is a serious challenge to Croatian policy makers and so it would be useful for the public’s perceptions and beliefs to be considered.
Highlights
Rationing or priority setting occurs at every level of every health system and is one of the most significant healthcare policy issues of the twenty-first century
Priority setting remains a big challenge to policy makers worldwide despite the growing research that has been done in this area
In a context of day-to-day healthcare priority setting decisions, taken by physicians, we aim to explore Croatian ethical principles concerning bedside rationing decisions, which parties they deem responsible for taking these decisions on their behalf and if they areawarethatpatientsprioritizationwillbecomea reality in a near future
Summary
Rationing or priority setting (terms we will use interchangeably, following Coulter and Ham, 2000) occurs at every level of every health system and is one of the most significant healthcare policy issues of the twenty-first century. Physicians have to manage the competing claims on their limited budgets, which are fixed at the macro level. They have to decide which patients to attend to first or, which ones not to treat at all. The economic approaches to healthcare micro allocation have had a limited success, partly because they do not properly incorporate the ethical considerations, which the physicians and the public face, when making rational priority setting decisions (Mitton and Donaldson, 2004). The results seem to indicate that the public supports multiple ethical principles and that those values vary at a cultural level. A successful policy of healthcare priority setting must take into account the values and culture of the population for which it is intended
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