Swedish politicians' view of obstacles when dealing with priority settings in health care.

PURPOSE: The purpose of this paper is to identify and describe main obstacles for politicians when dealing with healthcare priority setting. DESIGN/METHODOLOGY/APPROACH: The study had an exploratory descriptive design based on interviews with 18 politicians from two different county councils in Sweden. The interviews were analyzed using inductive qualitative content analysis. FINDINGS: The politicians highlighted the importance of, and difficulties in, communicate political missions; the politicians in this study saw the media as not always being fair watchdogs, implying that possibly important but unpopular prioritizing decisions were not made because of the risks of being badly reported and therefore not re-elected. Breaking up established structures in care practice is difficult and change takes time, partly because of existing higher level financing and rules and the system's traditional separation of facilities and services. Although the politicians highlighted their limited power to influence and control resource allocation they could give small and "lower profile", low-prioritized disciplines control of their own budgets and base payments on the results the disciplines accomplished. ORIGINALITY/VALUE: This study highlights the difficulties that politicians experience, for example, having to take unpleasant decisions and thereby run the risk of being scrutinized by media, which in turn could influence how effectively tax money is being used.

Lack of support structures in prioritization decision making concerning patients and resources. Interviews with Swedish physicians.

AIM: To investigate physicians' experiences in relation to prioritization and financing in health care in order to gain a deeper understanding of the reasons behind their standpoints. METHODS: Eighteen physicians, seven women and eleven men, aged 30 to 69 years were interviewed and the text was analyzed using an inductive approach, also described as conventional qualitative content analysis. RESULTS: Experience of setting healthcare priorities and difficult decision making differed widely among the physicians and seemed to be related to the number of years in professional practice. Their view of how resources should be allocated between disciplines/patients showed that they wanted politicians to make the decisions, with support from medical professions. The overwhelming impression of their reasoning showed that they lacked support structures for their decision making and could be understood under the following categories: prioritisation, easier in theory than in practice, and increasing costs threaten the Swedish welfare model. CONCLUSIONS: The findings of this study highlight the importance of practical national guidelines concerning vertical prioritization, also as an important measure to make prioritization more distinct and transparent. The physicians further had a need for tools to increase patients' awareness of their health. The findings of this study also showed that an awareness of the actual costs involved might increase the responsibility among both physicians and patients. The physicians' lack of support structures implies an urgent need for practical national guidelines, especially concerning vertical prioritization. This will also make prioritization appear clear and transparent for citizens.

Decision makers' experiences of prioritisation and views about how to finance healthcare costs.

OBJECTIVES: Prioritisation in healthcare is an issue of growing importance due to scarcity of resources. The aims of this study were firstly to describe decision makers' experience of prioritisation and their views concerning willingness to pay and how to finance healthcare costs. An additional aim was to compare the views of politicians and physicians. METHODS: The study was a cross-sectional study based on a questionnaire administered to 700 Swedish politicians and physicians. This was analysed using both quantitative and qualitative methods. RESULTS: A majority of the decision makers (55%) suggested that increasing costs should be financed through higher taxation but more physicians than politicians thought that higher patient fees, private health insurance and a reduction in social expenditure were better alternatives. Prioritisation aroused anxiety; politicians were afraid of displeasing voters while physicians were afraid of making medically incorrect decisions. CONCLUSIONS: This study do not answer the question about how to make prioritisation in health care but the result highlights the different ways that the decision makers view the subject and thereby elicit that publicly elected politicians and physicians perhaps not always work with the same goal ahead. There are needs for more research but also more media focus on the subject so the citizens will be aware and take part in the debate.

The views of physicians and politicians concerning age-related prioritisation in healthcare.

PURPOSE: The aim of this study is to describe the view of age-related prioritisation in health care among physicians and healthcare politicians and to compare their views regarding gender and age. DESIGN/METHODOLOGY/APPROACH: Swedish physicians (n=390) and politicians (n=310), mean age 52 years, answered an electronic questionnaire concerning age-related priority setting in healthcare. The questionnaire had fixed response alternatives with possibility of adding comments. FINDINGS: A majority of the participants thought that age should not influence prioritisation, although more physicians than politicians thought that younger patients should be prioritised. There were also significant differences concerning their views on lifestyle-related diseases and on who should make decisions concerning both vertical and horizontal prioritisation. The comments indicated that the politicians referred to ethical principles as a basis for their standpoints while the physicians often referred to the importance of biological rather than chronological age. RESEARCH LIMITATIONS/IMPLICATIONS: Web-based surveys as a method has its limitations as biased samples and biased returns could cause major problems, such as limited control over the drop-outs. The sample in this study was, however, judged to be representative. PRACTICAL IMPLICATIONS: The results indicate that supplementary guiding principles concerning prioritisation in healthcare are needed in order to facilitate decision-making concerning resource allocation on a local level. ORIGINALITY/VALUE: This paper adds important knowledge about decision makers' views on age-related priorities in healthcare, thus contributing to scientific base for prioritisation in healthcare and the ongoing debate in society.

Prioritization and resource allocation in health care: the views of older people receiving continuous public care and service.

OBJECTIVE: To describe the views of people, 65 years and over, receiving continuous public care and service, on prioritization and resource allocation in health care, in relation to gender, age, housing, health-related quality of life (QoL) and degree of activities of daily living (ADL) dependency. BACKGROUND: How older people receiving continuous public care and service view prioritization and resource allocation in health care is sparsely investigated, although this group most certainly has the experience and also often is the target in discussions concerning prioritization. It is necessary, for democracy and for the development of new models of service delivery, to find out how people receiving long-term care and service view these issues. DESIGN: 146 persons, 34 men (23%) and 112 women (77%), aged 66-100 years were interviewed face to face, following a structured questionnaire. RESULTS: The respondents thought that the patients' well-being, way of living and family situation should affect prioritization, not age per se. Resourcing of several health-care services were considered to be below what is required by a majority of the respondents. The respondents wanted doctors to decide on prioritization at an individual level and wanted higher taxes to finance increasing health-care costs. Although the respondents wanted publicly financed health care, a relatively high number were willing to pay for treatment. CONCLUSIONS: Knowledge of how older people receiving care and services, view prioritization and resource allocation has not previously been available. It seems that their views are in line with the Swedish Parliamentary Priority Commission which suggested that no account should be taken of age when allocating resources within the health-care system. Respondents' age, gender, housing, health-related QoL and degree of dependency in ADL had limited influence on their views of resource allocation.

Older people's reasoning about age-related prioritization in health care.

The aim of this study was to describe the reasoning of people aged 60 years and over about prioritization in health care with regard to age and willingness to pay. Healthy people (n = 300) and people receiving continuous care and services (n = 146) who were between 60 and 101 years old were interviewed about their views on prioritization in health care. The transcribed interviews were analysed using manifest and latent qualitative content analysis. The participants' reasoning on prioritization embraced eight categories: feeling secure and confident in the health care system; being old means low priority; prioritization causes worries; using underhand means in order to be prioritized; prioritization as a necessity; being averse to anyone having precedence over others; having doubts about the distribution of resources; and buying treatment requires wealth.

Older people's views of prioritization in health care. The applicability of an interview study.

AIM: Older people's views of prioritization in health care. The applicability of an interview study. Old age has been stated as a criterion for prioritization in health care, although older people are seldom asked for their opinions. The aim of this pilot study was to investigate the applicability of a questionnaire as a base for an interview study to explore older people's experiences and views of prioritization in health care. DESIGN: Descriptive, with a qualitative and quantitative approach. Fifty-four persons, 32 women and 22 men (aged 60-93 years), were asked to participate in a structured, tape-recorded interview covering their experience and views of the priorities applied in health care. RESULTS: The questions in the interview manual appeared to be applicable for collecting data concerning views of prioritization, but the analysis revealed that certain questions, particularly on economic matters, were missing. The procedure, a personal structured interview had advantages, for example, in capturing the respondents' reflections on the questions. The respondents emphasized the equal value of all human beings and that age is not a basis for prioritization within health care. The respondents also showed an unwillingness to precede anyone in rank. IMPLICATIONS: The questions used proved to be adequate but to be really complete further questions need to be added. This pilot study indicates that older people's views on priorities in health care differ from those expressed by the younger population. The study therefore needs to be replicated in a larger sample to be fully able to understand older people's views of prioritization, which will require exploring gender and age differences as well as other aspects that may explain variations.

Older people's views of prioritization in health care.

BACKGROUND AND AIMS: The aim of this study was to investigate and compare older people's views of prioritization in health care with specific regard to age, gender and HRQoL. METHODS: The sample was collected from a prospective longitudinal cohort study, the GAS project (Good Ageing in Skane) that is in progress in Sweden. For this study, 902 persons, 424 men and 478 women, aged between 60 and 93 years, were invited consecutively over a period of 17 months to participate in an additional structured interview based on an interview manual. Socio-demographic and HRQoL data were collected from the GAS project. For the analysis, the sample was divided into age groups: young-old, old-old, and oldest-old. RESULTS: Older people in general did not want age as a criterion for prioritization in health care. When pain was added as a criterion, age became even less important than when it was the sole criterion. The oldest-old, to a higher degree than the other age groups, prioritized younger patients, as did men, while women, more than men, preferred "old age" as an indicator for prioritization. The respondents' views on prioritization were also more associated with age and gender than HRQoL. CONCLUSIONS: Older people's views of priorities seem to differ from previous population-based studies, in that age per se as a criterion for selection between patients was not favored; health and wellbeing were more important. Differences were, however, found within the group of older people, as regards both age and gender.