ReviewAre physicians willing to ration health care? Conflicting findings in a systematic review of survey research☆
Section snippets
Background
Health care rationing, here understood as withholding beneficial interventions for cost reasons, occur at all levels in all health care systems around the world. Countries with very different health care systems and levels of health care spending all grapple with the challenge of reconciling a steadily increasing demand for health care services with limited or even declining financial resources. If health care rationing is inevitable, it must be done fairly and efficiently. Several approaches
Search strategy
We performed a systematic literature search using CINAHL (1982–December 2007), EMBASE (1988–December 2007), and MEDLINE (1966–December 2007). No time or language restrictions were applied. The keyword catalogue and indexing of articles differ considerably from database to database. This was of special importance in our case because the search algorithms had to reflect a broad review question including three core search terms: (1) quantitative survey research, (2) physicians as participants, and
Selection of studies
The systematic literature search yielded 557 references, of which 15 were eventually included in the systematic review after relevance assessment (see Table 1) [13], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29]. Cronbach's alpha was 0.91.
Characteristics and quality of selected studies
The 15 studies were conducted in 8 different countries (Canada, Italy, The Netherlands, Norway, Sweden, Switzerland, the United Kingdom, and the United States of America). Altogether, the studies included 10,921
Discussion
At first sight, an average score (mean) of 60.6% of general willingness to ration health care among physicians could indicate that there is substantial willingness to consider cost and efficiency data in addition to effectiveness data and patient preferences, when making medical decisions. The average score of 60.7% and 39.7% for acceptance of more specific strategies of rationing indicate that willingness to ration health care decreases when rationing is seen in practice. However, due to the
Acknowledgements
Funding: Supported in part by grant 01GP0608 from the German Federal Ministry of Education and Research and a grant for Daniel Strech from the German Academic Exchange Service.
References (37)
- et al.
Systematic review of qualitative studies exploring parental beliefs and attitudes toward childhood vaccination identifies common barriers to vaccination
Journal of Clinical Epidemiology
(2005) - et al.
The ethics of resource allocation: the views of general practitioners in Lincolnshire, UK
Social Science & Medicine
(1998) - et al.
Clinical and lay preferences for the explicit prioritisation of elective waiting lists: survey evidence from Wales
Health Policy (Amsterdam Netherlands)
(2003) - et al.
Primary care physicians’ attitudes to health care reform in England
Health Policy (Amsterdam, Netherlands)
(2002) - et al.
Value judgments in the analysis and synthesis of evidence
Journal of Clinical Epidemiology
(2008) Justice and managed care. Four principles for the just allocation of health care resources
The Hastings Centre Report
(2000)- et al.
Setting limits fairly
(2002) - et al.
A framework for rationing by clinical judgment
Kennedy Institute of Ethics Journal
(2007) - et al.
How to develop cost-conscious guidelines
Health Technology Assessment
(2001) - et al.
Constructing a systematic review for argument-based clinical ethics literature: the example of concealed medications
Journal of Medicine and Philosophy
(2007)
Challenges in systematic reviews: synthesis of topics related to the delivery, organization, and financing of health care
Annals of Internal Medicine
How physicians allocate scarce resources at the bedside. A systematic review of qualitative studies
Journal of Medicine and Philosophy
Rationale and standards for the systematic review of qualitative literature in health services research
Qualitative Health Research
Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators
PLoS Medicine
Systematic reviews of empirical bioethics. Conceptual challenges and practical recommendations
Journal of Medical Ethics
The measurement of observer agreement for categorical data
Biometrics
Coping with obligations towards patient and society: an empirical study of attitudes and practice among Norwegian physicians
Journal of Medical Ethics
Primary care physicians in Israel: self-perception of their role in the healthcare system and policy makers’ and patients’ perception of them as gatekeepers
The Israel Medical Association Journal
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