Comparing professional and non professionals views about equity efficiency tradeoffs in healthcare rationing.

Abstract

Introduction: In a context of scarcity, prioritizing patients is plagued with dificulties concerning eficiency-equity trade-offs. According to cost effectiveness analysis, the aim of a public health is to maximize the production of health. However, it has been increasingly obvious that social values, rather than being linear in potential health gains, seem to be increasing with the fair distribution of health care resources. Objectives: This study attempts to compare the opinion of two groups of the Portuguese society, people in general and health professionals, about: 1) eficiency-equity trade-offs related to intervention’s effect on patients’ health; 2) public involvement in health care rationing decisions. Methods: Quantitative methods were applied to data collected from a random sample of 180 college students and 60 health professionals. A questionnaire was developed with four hypothetical rationing exercises. In each scenario, due to scarcity of resources, respondents must decide which patient to choose. The exercises comprise tradeoffs between lengths of life and (i) quality of life; (ii) rule of rescue; (iii) cost of the treatment and (iv) rule of rescue and quality of life. Results: Findings suggest the existence of signiicant differences in the choices made by both groups. Health professionals seem to: 1) value more the length of life than the quality of life or the rule of rescue principle; 2) agree less with the direct involvement of the public in rationing decisions. Conclusions: Results suggest that healthcare professionals seem to be more in accordance with the eficiency principle while students seem to be more concerned with equity considerations.