On the relevance of personal responsibility in priority setting: a cross-sectional survey among Norwegian medical doctors

Bringedal, Berit; Feiring, Eli

doi:10.1136/jme.2010.038844

Cited by 24 publications

(25 citation statements)

References 12 publications

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“…Increasingly more governments are facing the choice between the two equally unpopular policies of either increasing fiscal pressure, or rationing healthcare. In particular, in publicly funded health systems, there is a recurrent debate on the possibility to ration healthcare treatments based on individual health behaviour (2)(3)(4)(5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Should I pay for your risky behaviours? Evidence from London

Miraldo¹,

Galizzi²,

Merla³

et al. 2014

Preventive Medicine

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We investigate the extent to which respondents from a general population sample in London (JulyAugust 2011) agree or disagree with the NHS covering the healthcare costs related to five risky health behaviours: overeating, unhealthy diet, sedentary life, excess of alcohol, and smoking. For each behaviour, we also directly explore the main factors associated with the likelihood to agree or disagree. Half of the respondents (N=146) manifest agreement with the idea. Wider agreement exists for covering the costs associated to smoking, heavy drinking, and sedentary lives than to overeating, or poor diets. With the exception of alcohol drinking and sedentaray life, there is an almost one-to-one relationship between the agreement that the NHS should pay the healthcare costs associated to a specific behaviour, and the respondents' actual engagement in that behaviour. Those at higher risk of depending on publicly funded healthcare, are more likely to agree.

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Section: Introductionmentioning

confidence: 99%

Should I pay for your risky behaviours? Evidence from London

Miraldo¹,

Galizzi²,

Merla³

et al. 2014

Preventive Medicine

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“…Bronchial asthma does not really play a decisive role here.' (Interview 24, physician) 2 'Well, I think … I can't think now why Karl L. should be prefered to Fritz C. That's not clear to me. Both of them are entitled to rehab.'…”

Section: Issues Patients Relatives Physicians Nursesmentioning

confidence: 97%

“…because of therapeutic benefi t X X because of social responsibility (X) no reasons given X X Decision refused … refused criterium: 'social status' (X) X 2 because decision-making is immoral (X) 1 'Pains, I think, have then to be cured, healed, faster than this mobile independance.' (Interview 21, nurse) 2 'Okay, for both life here is the same, only because the one is manager of a branch offi ce and the other "just househusband" -for me that is of no relevance at all.' (Interview 25, nurse) because of longer prospective (X) working life no reasons given X for Fritz C. (55 years; asthma) because of co-morbidity (asthma) (X) X no reasons given (X) X against Fritz C.…”

Section: Issues Patients Relatives Physicians Nursesmentioning

confidence: 99%

“…The reasons given by patients were that those costs were unjustifi ed for the other members of the health insurance, while physicians were more concerned about the risks involved for patients' health. Bringedal reported that concerning self-induced diseases, physicians were willing to consider exercise in patients as positive nevertheless [ 2 ] . Even though there was an awareness for the potential for cost reduction in health care in general, the overall opinion was that the healthcare of haemophilia patients has to be ensured by the statutory health insurance.…”

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confidence: 99%

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Prioritisation in Haemophilia A: A Qualitative Study of Stakeholder Attitudes and Preferences

et al. 2012

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To learn more about prioritisation in the health care system, we performed an exploratory qualitative study on haemophilia A. The aim was to generate haemophilia disease-specific criteria and to learn more about reasoning in the decision-making process. The 40 participants (patients, relatives, physicians, nurses) were asked in semi-structured interviews about their experiences regarding the German health care system in general and the management of haemophilia A. The 4 stakeholder groups agreed that treatment in haemophilia A was very good; there were complaints about increased bureaucracy. Arguments originated in personal past experiences (patients, relatives) and in the professional background (healthcare professionals). Decision-making criteria ranking high were the maintenance of mobility, social responsibility and the prospect of a long working life span. Criteria with lower ranking were a high social professional status and age. There was ambivalence as to whether savings in the healthcare system in general were necessary or inacceptable. Prophylactic factor administration was rejected when high-risk sports were practiced regularly. Decision-making among actual individuals was rejected as 'immoral'. Patient representatives should be included in the political decision-making process. In conclusion, solidarity in the German health insurance is a highly esteemed principle, but was not well comprehended. The findings demonstrate the variety of individual attitudes with strong context affinity to the disease and the background of the stakeholder groups. The challenge will be to find ways of prioritising in an accountable and transparent way to maintain an excellent health care service for the individual haemophilia patient while also serving the public good.

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“…Kravene til ansvarlig oppfølging av svaert kostbar behandling gjelder nåtidig og fremtidig utnytting av knappe ressurser. Dette må skilles fra en tenkning om at handlinger og livsstilsvalg gjort i fortid skal «straffe» pasientene slik at behandling av pasienter med «selvpåførte» sykdommer prioriteres ned (10). Selvpåført lidelse er i dag ikke et relevant kriterium i prioriteringsarbeidet (11,12).…”

Section: Rettferdighetunclassified