Abstract
BackgroundSocietal preferences have to be taken into consideration to ensure difficult healthcare decisions are legitimate and acceptable. It has been interesting to ascertain whether attitudes towards the principles of public healthcare resources allocation are homogenous. In particular, it has been thought provoking to ask whether advancement in medical technologies, and growing accessibility issues due to scarcity of healthcare resources, have influenced the beliefs of the general public with regard to allocative principles in recent years. The objective of this study was to compare preferences towards the distribution of healthcare resources between younger and older members of society.MethodsDiscrete choice experiments using the equivalence of numbers technique and the social welfare function were conducted in Poland. Public preferences towards disease severity, and potential to benefit, as well as aversion to inequity, were elicited. In order to ensure full understanding of questions by the older respondents, a pilot study with ten respondents aged 65+ was conducted.ResultsIn total, 52 adult respondents (seniors) and 45 students (juniors) were interviewed. While the first were unwilling to trade between different patients, the latter chose a higher number of individuals to compensate for the loss of ten patients with a more severe disease and a higher potential to treat everything else being equal. Juniors were more inequality averse compared to seniors as well.ConclusionsWhile the revealed preferences of seniors were egalitarian, juniors were more willing to differentiate between disease severity and potential to benefit. Differences in opinion between juniors and seniors should be considered in open dialogue regarding healthcare rationing. Insight into the preferences towards health maximization of the former group and the egalitarian beliefs of the latter group could be useful for decision makers in the search for public acceptance of allocation of scarce healthcare resources.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1210-8) contains supplementary material, which is available to authorized users.
Highlights
Societal preferences have to be taken into consideration to ensure difficult healthcare decisions are legitimate and acceptable
The contention is that there is a need for public engagement in the decision making processes regarding the allocation of limited healthcare resources
Our results indicate that it might be more difficult for seniors to accept healthcare rationing
Summary
Societal preferences have to be taken into consideration to ensure difficult healthcare decisions are legitimate and acceptable. It has been thought provoking to ask whether advancement in medical technologies, and growing accessibility issues due to scarcity of healthcare resources, have influenced the beliefs of the general public with regard to allocative principles in recent years. The growing accessibility of medical information has certainly raised the expectations of patients with regard to the various treatment options. The contrast between growing needs of patients and scarcity of financial resources lead to conflict between two objectives of the healthcare system: effectiveness and equity. If effectiveness is chosen over equity, decision makers tend to reimburse medical technologies offering the greatest health gains for the greatest number of individuals within given financial limits. If equity over effectiveness is chosen, patients with a severe disease or lack of alternative treatment options are primarily considered. The difficulties of meeting the needs of two contradictory objectives of a health care system may create some
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