Level Of Health Care Expenditures Research Articles

Does Renewable Energy Consumption Have an Effect on Health Expenditures? Example of EU Countries

Due to the harmful effects of traditional energy sources on the environment and health, the consumption of renewable energy sources has recently come to the fore on the world agenda. In order for national economies to maintain their existence, individuals must ensure their health and welfare. In this context, the priority duty of countries should be to protect public health and ensure its sustainability. There are many factors that determine a country's level of healthcare expenditures; environmental conditions are also one of them. The increase in greenhouse gas emissions resulting from the consumption of non-renewable energy sources can pose a great danger to human welfare and the environment. Environmental problems caused by greenhouse gas emissions negatively affect human health in many ways, such as affecting the nervous system, lungs, and causing respiratory diseases. In addition, environmental pollution resulting from greenhouse gas emissions increases health expenditures and causes a decrease in labor productivity. Considering these negative effects, increasing the use of wind, solar, geothermal, and other environmentally friendly energy sources, which are renewable energy sources, will contribute to environmental improvement by meeting the energy needs of countries. Recently, the increase in the resources allocated to health expenditures from the national income of countries has made the discussion of sustainability in the relevant field a current issue. In this respect, researching the factors affecting health expenditures will provide important information to policy makers. This study examines the health expenditures of renewable energy consumption in 13 EU countries (Belgium, Czech Republic, Denmark, Germany, Austria, Spain, Sweden, Italy, Portugal, Greece, Finland, France, and the Netherlands) selected considering data availability between 2000 and 2020 investigating in which direction it affects. In the study, countries with the highest consumption of renewable energy were selected. Since the sustainability of the recently increasing health expenditures is important, the variables of renewable energy consumption and economic growth were analyzed and the subject was limited. In this context, it is believed that the findings will provide important information to policy makers. The main motivation of the study is that there are limited studies on the relevant subject in the literature and panel cointegration and panel cointegration coefficient estimator tests are not used. Obtaining renewable energy consumption and health expenditure data from 2000 to 2020 constitutes the main limitation of the study. As analysis methods, Lagrange multiplier (LM) cointegration and Common Corelated Effect (CCE) cointegration estimator tests were used. Before the application of these tests, cross-sectional dependence and homogeneity were determined. Fourier LM unit root test was used in examining the unit root process. Then, cointegration test and cointegration coefficient estimators, which is the last stage of the application, were determined. According to the panel cointegration coefficient estimation results, in the general analysis conducted for 13 EU countries, the effect of renewable energy consumption on health expenditures is statistically significant at the 10% level. Accordingly, a 1% increase in renewable energy consumption decreases health expenditures by 0.197%. In country-specific studies, the effect of renewable energy consumption on health expenditures was statistically significant and negative in Denmark, Spain, Sweden, and Greece, reducing health expenditures by 0.132%, 0.111%, 1.288%, and 0.782%, respectively. The effect of GDP on health expenditures appears to be statistically significant at the 1% level. Accordingly, a 1% increase in income increases health expenses by 1.071%. In country-based analyses, the coefficients are statistically significant and positive in Germany, Austria, Belgium, Czech Republic, France, Spain, Sweden, Italy, Portugal, and Greece. These findings indicate that the increase in environmentally friendly, reusable energy consumption will have a positive impact on the environment, reduce health expenditures and contribute positively to the sustainability of health financing. In addition, it emphasizes that increases in GDP are reflected in health expenditures, thus increasing the quality of health.

The Migration Influence on the Forecasting of Health Care Budget Expenditures in the Direction of Sustainability: Case of Ukraine

The start of the full-scale Russian-Ukrainian war caused the largest wave of migration in the 21st century. More than five million Ukrainian citizens left for EU countries within a few months of the start of the conflict. The purpose of this paper is to forecast the level of health care expenditure in Ukraine for 2023–2024, considering the scale of migration and the fall in the level of GDP. The authors propose three scenarios for the development of Ukraine’s economy in 2023–2024, taking into account changes in the age structure of the population, migration, and the amount of health care expenditure: (1) Pessimistic, in which economic growth will resume only in 2024, with a GDP rise of 5.6%, provided that the war concludes at the end of 2022. Under this scenario, inflation will be about 21% in 2023–2024, a slight decrease compared with the previous year. Some 12% of the population of Ukraine will have emigrated, resulting in a corresponding 12% drop in health care expenditure in 2023–2024. (2) Basic (realistic), in which economic growth will be about 5% in 2023–2024, inflation will be under 10%, and migration will have accounted for 5% of the country’s population. Under this scenario, there will be an increase in health care expenditure of more than 40% in 2023–2024. (3) Optimistic, according to which rapid economic growth is expected in 2023–2024, inflation will not exceed 7%, the majority of those who left Ukraine in the early months of the war will return, and health care expenditure will increase by more than 70% in 2023–2024. The methodology of forecasting public expenditure on health care has been based on a six-step cohort method. The results have indicated that the cost of updating the age structure of Ukraine’s population every year will decrease due to the aging of the population, and the overall impact of demographic processes will be negative. The impact of mass migration due to the war creates a significant change in health care costs, requiring administrative bodies to monitor the situation promptly and make appropriate changes to the structure of budget expenditure.

Comparative analysis of indicators that determine the effectiveness of the implementation of socio-economic determinants of health in Europe and Ukraine

The introduction of national strategies aimed at improving the well-being of the population of the country is one of the current approaches to reforming the public policies of the countries of the world. It is the socioeconomic determinants of health that determine the conditions in which people are born, grow, live and getting old, as well as the spheres of influence on these conditions, such as public policy, state of economic development, demographic trends, etc.
 The aim. In this way, our research has focused on a comparative analysis of macroeconomic indicators that determine the effectiveness of socioeconomic determinants of healthсare in Europe and Ukraine, that are used to provide scientific justification for the construction of humanistic models for the provision of pharmaceutical care to the population in the context of the rapid stratification of Ukrainian society according to socioeconomic indicators.
 Materials and methods. The research methodology is based on the principles of systems analysis and an interdisciplinary scientific and systemic approach. The study used the empirical method, the method of comparative analysis and synthesis of statistical data, the graphical method.
 Results. A comparative analysis of the socioeconomic determinants of health in the countries of the European region and in Ukraine was carried out on three levels of indicators: the level of health-care expenditure, the structure of health-care expenditure and expenditure on medicines.
 The analysis revealed that in 2019, the average health expenditure of the countries analyzed was 8.2 % of GDP. Only two of the 34 countries - Ukraine and Turkey - have a rate below the 5 % that recommended by WHO.
 Public health financing schemes and compulsory health insurance are the main funding mechanisms in all countries, with the exception of Cyprus. Ukraine, Russia, Greece, Latvia and Bulgaria have the largest share of direct costs to patients as a source of health care financing.
 The results of the analysis of the medicine expenditure indicator as a proportion of total health expenditure showed that the highest level was in Bulgaria (35.4 %), the lowest in Denmark (6.4 %). Overall, five countries have high levels of pharmaceutical expenditures.
 In most European countries, the cost of purchasing medicines has been found to range from 346 to 619 USD per person per year. The highest value of this indicator from the European region is in Switzerland (894 USD per person), and the lowest is in Ukraine (73 USD).
 Based on the results of the comparative analysis, the countries were grouped according to key indicators into three categories - high, medium and low.
 Conclusions. A comparative analysis of key indicators of the socio-economic determinants of health in the country of the European region has been carried out

Expenditure on health care in Poland compared to selected countries in 2010–2019

The aim of the study is to evaluate healthcare from the perspective of healthcare expenditure between 2010–2019. The author examined how the level of healthcare expenditure as a share of GDP, as well as per capita developed in the 2010–2019 period. Expenditure on health care grew for most of the 1999–2010 period, but nevertheless stabilized at a level below 7% of GDP in year 2010 and were one of the lowest in OECD countries, also lower than the compared reference countries (Czech Republic, Slovakia, Hungary). The author explored the topic of healthcare expenditure in the consecutive decade (2010–2019) and made comparisons of international expenditures with those of OECD countries, and in particular with reference countries. Additionally, on the basis of some selected analyzes, he confirms the fact known in health economics that an appropriate level of expenditure on healthcare has a positive impact on the health status of the population and the quality of healthcare offered in a country.

Spatial Analysis of the Relationship between Health Capital and the Level of Health Care Expenditure in Poland

Purpose: Considering the importance of social health in the national economy the aim of the article is to diagnose the level of health capital and health expenditure as well as to analyse the impact of expenditure on the level of health capital and to assess the spatial differentiation of their spatial distribution. Approach/Methodology/Design: The analysis was carried out in spatial terms at the NUTS 3 level for the years 2013-2019; the main source of data was the Local Data Bank of Statistics Poland. Taxonomic hierarchization methods (model-free) and classification of multi-feature objects were used. As a result, each object has been assigned a synthetic measure-indicator of the level of health capital (HCV) and an indicator of the level of expenses on health (HCM). Findings: There is a statistically significant negative nature of the relationship between the analysed categories. The spatial systems of the analysed measures differed from each other. One of the features most strongly influencing the level of health capital turned out to be the location and distance of a given unit (county) in relation to a larger urban centre, which is the centre of local growth. Practical Implications: The used approach at the local level provides institutions, local government authorities and all other interested units with important information that can be used in planning specific instruments supporting individuals with a deficit level of health capital. Originality/Value: In this paper has been suggested that it is necessary to increase expenditure on health in units with a relatively low level of health capital to deal with inequalities in this area and support local development. Otherwise, local governments that are currently in the worst situation in the future may never even come close to the level of the phenomenon in the most developed areas, which at the same time will constantly distance the others.

Програмно-цільовий метод і проблеми його застосування в період реформування фінансування галузі охорони здоров’я

The publication is aimed at defining problems and directions for improving the program-target method in the healthcare during the reform of this industry sector. The article analyzes the program-target method and its use in the planning of expenditures in the field of healthcare, the process of implementation of budget programs in this sphere in the Zhytomyr region. It is determined that the program-target method is important in the formation of healthcare expenditures, but it can potentially further increase the effectiveness of the distribution of budget funds. Despite the actual reduction of healthcare expenditures in the structure of consolidated budget expenditures, the introduction of the target method has inluenced the rational use of budget funds in the field of healthcare. This indicates the feasibility of this method in the budget process. The problems of the program-target method in the formation of healthcare expenditures are substantiated, the main of which are: the lack of medium- and long-term budget planning, a large number of budget programs, the lack of financial indicators in the system of effective indicators, reducing the level of healthcare expenditures. It is proposed: to introduce medium- and long-term budget planning, which will allow to clearly form the targets and results of budget programs in the field of healthcare for several years and consolidate financial resources for the specified targets; to develop a system of financial indicators within the system of effective indicators, which will be based on the expenditures of budget funds for the patient, to form the prerequisites for saving budget funds.

A cost-of-illness analysis of \u03b2-Thalassaemia major in children in Sri Lanka \u2013 experience from a tertiary level teaching hospital

BackgroundSri Lanka has a high prevalence of β-thalassaemia major. Clinical management is complex and long-term and includes regular blood transfusion and iron chelation therapy. The economic burden of β-thalassaemia for the Sri Lankan healthcare system and households is currently unknown.MethodsA prevalence-based, cost-of-illness study was conducted on the Thalassaemia Unit, Department of Paediatrics, Kandy Teaching Hospital, Sri Lanka. Data were collected from clinical records, consultations with the head of the blood bank and a consultant paediatrician directly involved with the care of patients, alongside structured interviews with families to gather data on the personal costs incurred such as those for travel.ResultsThirty-four children aged 2–17 years with transfusion dependent thalassaemia major and their parent/guardian were included in the study. The total average cost per patient year to the hospital was $US 2601 of which $US 2092 were direct costs and $US 509 were overhead costs. Mean household expenditure was $US 206 per year with food and transport per transfusion ($US 7.57 and $US 4.26 respectively) being the highest cost items. Nine (26.5%) families experienced catastrophic levels of healthcare expenditure (> 10% of income) in the care of their affected child. The poorest households were the most likely to experience such levels of expenditure.Conclusionsβ-thalassaemia major poses a significant economic burden on health services and the families of affected children in Sri Lanka. Greater support is needed for the high proportion of families that suffer catastrophic out-of-pocket costs.

General practice location and malpractice litigation.

Healthcare systems in many countries struggle to recruit general practitioners (GPs) for clinics in rural areas leading to less GPs for an increasing number of patients. As a result, fewer resources are available for individual patients, potentially influencing patient satisfaction and the likelihood of malpractice litigation. The aim of this study was to investigate the association between malpractice litigation and local setting characteristics in a Danish national sample of GPs considering rurality, number of patients listed with the GP, as well as levels of local unemployment, education, income and healthcare expenditure. This is a register study on Danish complaint files and administrative register data using multivariate logistic regression. No statistical significant association could be established between litigation figures and rurality, occupation with respect to education, and municipality level of healthcare expenditures. However, larger patient list size was associated with higher rates of malpractice litigation (odds ratio (OR) 1.05 per 100 patients). Litigation was less frequent in settings with higher income patient populations (OR 0.65), although where it did occur the criticism seemed much more likely to be justified (OR 6.03). Many GPs face an increasing workload in terms of patient lists. This can cause drawbacks in terms of patient dissatisfaction and malpractice litigation even though local factors such as economic wealth apparently interfere. Further research is needed about the role of geographic variations, workload and socioeconomic inequality in malpractice litigation.

CO2 Emissions, Environmental Degradation, and Healthcare Expenditure: Evidence from Australia

Environmental degradation (measured, for example) by CO2 emissions has an adverse effect on public health, leading to the need for a higher level of healthcare expenditure. The level of per capita income, which has been identified as a major determinant of healthcare expenditure, is associated with environmental degradation as represented by the environmental Kuznets curve. The results presented in this study show that when a country, like Australia, falls on the declining sector of the Environmental Kuznets Curve (EKC), healthcare expenditure is negatively related to environmental degradation. Although this proposition sounds counterintuitive, it is justified theoretically and supported empirically.

Fiscal rules, powerful levers for controlling the health budget? Evidence from 32 OECD countries

BackgroundPublicly funded healthcare forms an intricate part of government spending in most Organisation for Economic Co-operation and Development (OECD) countries, because of its reliance on entitlements and dedicated revenue streams. The impact of budgetary rules and procedures on publicly funded health care might thus be different from other spending categories. In this study we focus on the potential of fiscal rules to contain these costs and their design features.MethodsWe assess the relationship between fiscal rules and the level of public health care expenditure of 32 (OECD) countries between 1985 and 2014. Our dataset consists of health care expenditure data of the OECD and data on fiscal rules of the International Monetary Fund (IMF) for that same period. Through a multivariate regression analysis, we estimate the association between fiscal rules and its subcategories and inflation adjusted public health care expenditure. We control for population, Gross Domestic Product (GDP), debt and whether countries received an IMF bailout for the specific period. In all our regressions we include country and year fixed effects.ResultsThe presence of a fiscal rule on average is associated with a 3 % reduction of public health care expenditure. Supranational balanced budget rules are associated with some 8 % lower expenditure. Health service provision-oriented countries with more passive purchasing structures seem less capable of containing costs through fiscal rules. Fiscal rules demonstrate lagged effectiveness; the potential for expenditure reduction increases after one and two years of fiscal rule implementation. Finally, we find evidence that fiscal frameworks that incorporate multi-year expenditure ceilings show additional potential for cost control.ConclusionsOur study shows that there seems a clear relationship between the potential of fiscal rules and budgeting health expenses. Using fiscal rules to contain the level of health care expenditure can thus be a necessary precondition for successful strategies for cost control.

THE GOLDEN RULE OF LONGEVITY

How much should society invest in medical care that extends the lives of the older generations? We derive a golden rule for the level of health care expenditures and find that the optimal level of life-extending health care expenditures should increase with rising productivity, increase with the retirement age, and also increase with the population growth rate if a higher growth rate lowers the ratio of retirees to working-age people sufficiently, while the effects of an improvement in medical technology are ambiguous. Moreover, we find that a market economy may be inefficient in terms of the provision of life-extending health care because an individual ignores the effect of his own longevity on the income of others.

Problems of Economic Security of Health Care Institutions

The special attention to the problems of economic security of health care institutions is paid in the paper. The essence of the category «health care institution» and its classification are considered. Such problems of the economic security of health care institutions were identified as insufficient level of budget financing, loss of scientific and qualified personnel, decline of use of innovative products, increasing dependence on imported medicines, increasing circulation of counterfeit medicines. The direct threat to the security of health care institutions under the influence of an open reorganization of state and municipal health care institutions in state and communal non-profit enterprises is determined. The main statistical trends of budget financing of health care institutions in Ukraine are studied due to the volume of expenditures on the branch. The reasons for the low level of financing are determined; the mathematical model of the dependence of the nominal gross domestic product and expenditures on health protection is formed. The extremely low level of health care expenditures in Ukraine is noted in comparison with other countries. The negative dynamics of availability of doctors and medical personnel in the country was revealed. The using of outdated fixed assets and equipment in health care institutions and the Ministry of Health’s inability to provide them with new equipment are determined in the paper. The pharmaceutical market in the state is analyzed and the growing dependence of health care institutions on imported medicines is established. The content of falsification of medicinal products due to the possible absence of active substance in preparations, unknown technologies of obtaining medicinal products and substituting medicinal substances for cheaper analogues are disclosed. The sources of receipt of counterfeit medicines to health care institutions have been established. The authors use such research methods as analysis and synthesis, abstraction and generalization, comparison, statistical method, method of mathematical modeling.

Informing Decisions in Global Health: Cost Per DALY Thresholds and Health Opportunity Costs

In this policy brief, Karl Claxton and colleagues argue that the cost per DALY threshold used to judge the cost-effectiveness of an intervention should reflect evidence of the likely health opportunity costs in the settings and health care systems (HCS) in which it will be used. Heath opportunity costs are the amount of health that a HCS currently delivers with more or less resources. The effect of different levels of health care expenditure on health outcomes has been investigated in a number of published studies using country level data, many including low- and middle-income countries (LMICs). Despite the challenges of estimation, initial estimates are available for 123 countries. These need to be updated and refined as more and better data become available. Cost-effectiveness ‘thresholds’ (cost per DALY or cost per QALY) that have been recommended, or have become widely cited, are not founded on an assessment of the likely health opportunity costs. Their use is likely to reduce rather than improve health outcomes overall.

The concentration of health care expenditures in the U.S. and predictions of future spending

Estimates of health care expenses for the U.S. population are critical to policymakers and others concerned with access to medical care and the cost and sources of payment for that care. Medical care expenses, however, are highly concentrated among a relatively small proportion of individuals in the community population. Using information from the Household Component of the Medical Expenditure Panel Survey (MEPS-HC), this study provides detailed estimates of the concentration and persistence in the level of health care expenditures in the United States. Attention is given to identifying the characteristics of individuals with the highest levels of medical expenditures, in addition to those factors that are associated with low medical expense profiles. Analyses are included to discern the most salient factors that serve to predict the likelihood of experiencing high levels of medical expenditures in a subsequent year, in addition to the factors operational in predictions of experiencing low levels of medical expenditures in a subsequent year.

Factors associated with patterns of plural healthcare utilization among patients taking antiretroviral therapy in rural and urban South Africa: a cross-sectional study

BackgroundIn low-resource settings, patients’ use of multiple healthcare sources may complicate chronic care and clinical outcomes as antiretroviral therapy (ART) continues to expand. However, little is known regarding patterns, drivers and consequences of using multiple healthcare sources. We therefore investigated factors associated with patterns of plural healthcare usage among patients taking ART in diverse South African settings.MethodsA cross-sectional study of patients taking ART was conducted in two rural and two urban sub-districts, involving 13 accredited facilities and 1266 participants selected through systematic random sampling. Structured questionnaires were used in interviews, and participant’s clinic records were reviewed. Data collected included household assets, healthcare access dimensions (availability, affordability and acceptability), healthcare utilization and pluralism, and laboratory-based outcomes. Multiple logistic regression models were fitted to identify predictors of healthcare pluralism and associations with treatment outcomes. Prior ethical approval and informed consent were obtained.ResultsNineteen percent of respondents reported use of additional healthcare providers over and above their regular ART visits in the prior month. A further 15% of respondents reported additional expenditure on self-care (e.g. special foods). Access to health insurance (Adjusted odds ratio [aOR] 6.15) and disability grants (aOR 1.35) increased plural healthcare use. However, plural healthcare users were more likely to borrow money to finance healthcare (aOR 2.68), and incur catastrophic levels of healthcare expenditure (27%) than non-plural users (7%). Quality of care factors, such as perceived disrespect by staff (aOR 2.07) and lack of privacy (aOR 1.50) increased plural healthcare utilization. Plural healthcare utilization was associated with rural residence (aOR 1.97). Healthcare pluralism was not associated with missed visits or biological outcomes.ConclusionIncreased plural healthcare utilization, inequitably distributed between rural and urban areas, is largely a function of higher socioeconomic status, better ability to finance healthcare and factors related to poor quality of care in ART clinics. Plural healthcare utilization may be an indication of patients’ dissatisfaction with perceived quality of ART care provided. Healthcare expenditure of a catastrophic nature remained a persistent complication. Plural healthcare utilization did not appear to influence clinical outcomes. However, there were potential negative impacts on the livelihoods of patients and their households.

Out‐of‐pocket costs for paediatric admissions in district hospitals in Kenya

ObjectiveTo describe out-of-pocket costs of inpatient care for children under 5 years of age in district hospitals in Kenya.MethodsA total of 256 caretakers of admitted children were interviewed in 2-week surveys conducted in eight hospitals in four provinces in Kenya. Caretakers were asked to report care seeking behaviour and expenditure related to accessing inpatient care. Family socio-economic status was assessed through reported expenditure in the previous month.ResultsSeventy eight percent of caretakers were required to pay user charges to access inpatient care for children. User charges (mean, US$ 8.1; 95% CI, 6.4–9.7) were 59% of total out-of-pocket costs, while transport costs (mean, US$ 4.9; 95% CI, 3.9–6.0) and medicine costs (mean, US$ 0.7; 95% CI, 0.5–1.0) were 36% and 5%, respectively. The mean total out-of-pocket cost per paediatric admission was US$ 14.1 (95% CI, 11.9–16.2). Out-of-pocket expenditures on health were catastrophic for 25.4% (95% CI, 18.4–33.3) of caretakers interviewed. Out-of-pocket expenditures were regressive, with a greater burden being experienced by households with lower socio-economic status.ConclusionDespite a policy of user fee exemption for children under 5 years of age in Kenya, our findings show that high unofficial user fees are still charged in district hospitals. Financing mechanisms that will offer financial risk protection to children seeking care need to be developed to remove barriers to child survival.

Health and Morbidity in the Accession Countries Country Report - Poland

The objective of this report is to analyse the prevalence of good and poor health in Poland and the impact of self-assessed health on the use of health care services. Special attention is given to the impact of ageing on health status and the utilisation of health care. In addition, other social and economic factors that underpin health status and drive the utilisation of health care services are described. The analysis differentiates utilisation by type of medical service, including primary care, consultations with specialists and hospital care. The main research question is whether the ageing process is leading to a worsening health status of the population or if living longer means living in better health. The answer to this question implies possible changes in the structure of medical care utilisation and – finally – allows for recognition of the impact of population ageing on the level of health care expenditure.

Perspectives Articles:Exploring Stakeholder Perspectives on What Is Affordable Health Care

AbstractHealth care expenditures have accounted for increasing proportions of the U.S. gross domestic product, and the rate of growth of health care expenditures has increased over the past two decades. These two measures of assessing whether the level of health care expenditures is affordable may be appropriate in the aggregate for the United States but are not appropriate to assess whether individual stakeholder groups can afford their particular level of spending on health care. Health care is an economic good that differs from other economic goods, as it involves life and death issues, and invokes a call for a moral authority. This article explores definitions of what is affordable health care from the perspective of different stakeholders and suggests that other measures are needed to assess whether or not health care is affordable for stakeholders as one definition is not appropriate for all stakeholders.

Information technology for patient safety

BackgroundResearch on patient care has identified substantial variations in the quality and safety of healthcare and the considerable risks of iatrogenic harm as significant issues. These failings contribute to the...

The effect of priority setting decisions for new cancer drugs on medical oncologists' practice in Ontario: a qualitative study

BackgroundHealth care policies, including drug-funding policies, influence physician practice. Funding policies are especially important in the area of cancer care since cancer is a leading cause of death that is responsible for a significant level of health care expenditures. Recognizing the rising cost of cancer therapies, Cancer Care Ontario (CCO) established a funding process to provide access to new, effective agents through a "New Drug Funding Program" (NDFP). The purpose of this study is to describe oncologists' perceptions of the impact of NDFP priority setting decisions on their practice.MethodsThis is a qualitative study involving semi-structured, in-depth interviews with 46 medical oncologists in Ontario. Oncologists were asked to describe the impact of CCO's NDFP drug funding decisions on their practice. Analysis of interview transcripts commenced with data collection.ResultsOur key finding is that many of the medical oncologists who participated in this study did not accept limits when policy decisions limit access to cancer drugs they feel would benefit their patients. Moreover, overcoming those limits had a significant impact on oncologists' practice in terms of how they spend their time and energy and their relationship with patients.ConclusionWhen priority setting decisions limit access to cancer medications, many oncologists' efforts to overcome those limits have a significant impact on their practice. Policy makers need to seriously consider the implications of their decisions on physicians, who may go to considerable effort to circumvent their policies in the name of patient advocacy.