Who Shall Not Be Treated: Public Attitudes on Setting Health Care Priorities by Person-Based Criteria in 28 Nations

Abstract

The principle of distributing health care according to medical need is being challenged by increasing costs. As a result, many countries have initiated a debate on the introduction of explicit priority regulations based on medical, economic and person-based criteria, or have already established such regulations. Previous research on individual attitudes towards setting health care priorities based on medical and economic criteria has revealed consistent results, whereas studies on the use of person-based criteria have generated controversial findings. This paper examines citizens’ attitudes towards three person-based priority criteria, patients’ smoking habits, age and being the parent of a young child. Using data from the ISSP Health Module (2011) in 28 countries, logistic regression analysis demonstrates that self-interest as well as socio-demographic predictors significantly influence respondents’ attitudes towards the use of person-based criteria for health care prioritization. This study contributes to resolving the controversial findings on person-based criteria by using a larger country sample and by controlling for country-level differences with fixed effects models.

Severity as a Priority Setting Criterion: Setting a Challenging Research Agenda

“…Otherwise, we believe that the long-term legitimacy of official priority setting policy may be compromised. This concern builds on a literature of the role of the social contract in health care policy, originating with John Rawls and Norman Daniels [20,21,86], but also more recent research on the need for legitimacy in priority setting [15,30,91,95,122]. It may be prudent, therefore, to analyse severity both as an essentially contested concept [16,32], and severity as (at least temporary) a basis for incompletely theorized agreements [92,113].…”

Economic decisions on who to treat when resources are not enough for everyone. Evidence from a Spanish survey

“…In addition, an increasing number of empirical studies l have been conducted around the world in order to find out which of these criteria are supported by the general public, on whose behalf health care rationing decisions are being made. Whereas medical based principles seem to be generally considered as valid for priority setting (11)(12)(13)(14), there is not enough information on whether economic (13)(14)(15)(16)(17)(18)(19) or patient-based criteria (18)(19)(20)(21)(22)(23) are acceptable by the general public for this purpose. However, it is not possible to draw any detailed conclusion from these studies, since their results vary depen-ding on aspects such as the countries that were surveyed, the operationalization that was chosen, and the research design (22).…”

Asking the public: Citizens´ views on priority setting and resource allocation in democratically governed healthcare

“…or on the interactions and discussions between citizens, e.g. in focus groups (Coast, 2001;Coast, Donovan, Litva, Eyles, Morgan, Shepherd & Tacchi, 2002;de Fine Licht, 2011;Diederich, Winkelhage & Wirsik, 2011;Fredriksson, Eriksson & Tritter, 2018;Litva et al, 2002;Richardson, Charry & HammerLloyd, 1992;Rogge & Kittel, 2016;Werntoft, Edberg, Rooke, Hermeren, Elmstahl & Hallberg, 2005;Winkelhage & Diederich, 2012;Wiseman, Mooney, Berry & Tang, 2003).…”

“…Even if there are similarities between countries, doubts have been raised as to whether there exist any universal values that could support priority setting, when it comes to process or content values (Biron et al, 2012;Clark & Weale, 2012;Kieslich, 2012;Littlejohns, Sharma & Jeong, 2012;. In light of the importance given to ethical principles and criteria to be in line with social values for the legitimacy of priority setting, more studies ought to include values held by the public (Clark & Weale, 2012;Frankish et al, 2002;Rogge & Kittel, 2016;Sabik & Lie, 2008). As social values, as the concept is used in this thesis, are values held by the public in each society at a particular time, country specific studies are important (Biron et al, 2012;Clark & Weale, 2012).…”

“…This was an important finding as the importance of ethical principles being in line with social values has been emphasised for the legitimacy of priority setting (Clark & Weale, 2012;Frankish et al, 2002;Rogge & Kittel, 2016;Sabik & Lie, 2008). However, agreement generally tends to decrease when vague principles are more precisely defined (Liss, 2008), and neither patient groups, nor representatives of the public have been involved in the process of operationalising the severity criterion into the Severity Framework in Sweden.…”