Knowing about healthcare rationing

• Main Author: Owen-Smith, Amanda
• Published: University of Bristol 2008
• Subjects: 361
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.486124

How best to manage the obligation to ration healthcare, and in particular how explicit such priority setting processes should be, is a matter of increasing international interest. Despite this, there exists very limited empirical evidence about the views of clinicians on this issue, and none relating to the views of patients. Qualitative research methods were used to conduct a multi-stage empirical investigation, including an initial study at the community level, followed by two clinical case studies (of morbid obesity and breast cancer treatments) within secondary care. In total, 21 healthcare professionals and 31 patients were interviewed. Purposive and theoretical sampling methods were used and data were analysed using methods of constant comparison. The results revealed that patients had a broad awareness of healthcare rationing, and nearly all said they wanted to know how financial factors affected the provision of their healthcare. However, the data also demonstrated that the experience of explicit rationing could be extremely distressing for patients, particularly when decision-making was viewed as arbitrary or unfair. Clinical professionals reported a strong theoretical commitment to being open about rationing, although in practice this was sometimes over-ridden by ethical or pragmatic concerns, meaning that more implicit approaches were often employed. Patients had a choice whether to accept explicit rationing decisions, protest against them, or pay for private care. However, options were often constrained because of lack of personal resour~es or inadequate access to information. In conclusion, explicit rationing is generally favoured by clinicians and patients, and is amenable to being managed within the shared decision-making model of the doctor-patient relationship. However, clinicians need further training to assist them in appropriate disclosure techniques, and patients need access to adequate information about the basis for rationing decisions, and the possible routes to contest them, to ensure their involvement is meaningful.