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.
Highlights
As a consequence of budget constraints in all western health care systems, priority setting seems inevitable
Most of the physicians broached the issue of costs as an argument in favor of the feeding stop; they considered the costs to be too high in view of budget constraints in the health care system
In the study reported here we used a qualitative approach to investigate in detail decisions and rationales used by patients and physicians regarding the limitation of treatments with problematic or unproven therapeutic benefit and high costs, respectively
Summary
As a consequence of budget constraints in all western health care systems, priority setting seems inevitable. Several studies show that laypersons as well as physicians strongly support the therapeutic benefit as a criterion for prioritizing medical services [4,5,6], whereas priority setting on the basis of costs is less accepted by both groups [4,7]. Studies comparing the attitudes of physicians and the general public regarding costs and therapeutic benefit for prioritizing health services show some differences between these two groups [8,9,10]. Objective: To compare physicians and patients regarding their understanding and use of therapeutic benefit and treatment costs as criteria for prioritizing health care. 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. 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
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have