Ethics, health policy-making and the economic crisis: a qualitative interview study with European policy-makers

Caroline Brall,Rouven Porz,Helmut Brand,Farhang Tahzib,Peter Schröder-Bäck

doi:10.1186/s12939-019-1050-y

Abstract

BackgroundThe economic crisis posed various challenges to policy-makers who had to decide on which health policy measures to focus on and on which to refrain from. The aim of this research was to assess the relevance of ethics and to highlight ethical dimensions in decision-taking by policy-makers with regard to policy and priority-setting in health systems posed by the economic crisis.MethodsSemi-structured qualitative interviews were conducted with eight European policy-makers from six countries.ResultsAll interviewees recalled difficult and strenuous situations where they had to prioritise between distinct areas to focus on and invest in, for example around choices between prioritising medications, health professional staffing, care specific equipment, or urgent infrastructure issues. Values could be identified which they deemed as important within the policy-making process, such as trust and responsibility. They explicitly expressed the need for ethical tools and assistance in terms of policy advice for reaching morally sustainable decisions in health policy matters.ConclusionsThe study showed that ethical concepts and values frequently come into play in health policy-making, and that ethics is highly relevant in policy-makers’ daily decision-taking, yet that they lack ethical guidance on what to base their decisions. The study is of relevance since it can provide future decisions on austerity-related issues with an ethical underpinning and could identify areas of moral concern.

Highlights

The economic crisis posed various challenges to policy-makers who had to decide on which health policy measures to focus on and on which to refrain from
An interview study with European Union (EU) policy-makers aimed to assess how they a) perceived the economic crisis with regard to health, b) which values they perceive as essential to be integrated in policymaking during challenging situations with regard to priority-setting and decision-making in health policy matters, and c) how they evaluate the role of ethics in political decision-making
Previous studies have assessed the perspectives of health care professionals on austerity measures in health care provision [12, 13], with one study shedding light on professionalism and ethical issues encountered by health care professionals [14]

Summary

Introduction

The economic crisis posed various challenges to policy-makers who had to decide on which health policy measures to focus on and on which to refrain from. Whereas Iceland or Sweden, for example, chose financial stimulus and invested in social safety nets etc., countries including Portugal, Spain, Ireland and Greece had to employ austerity measures as part of structural rearrangements so as to receive funds issued by the International Monetary Fund (IMF) [1, 2]. For the latter countries, the economic policy as a response to. As Sullivan and Segers describe, politicians and policy-makers act in a “distinctive realm” as they “act for others and serve

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