Citizens, their agents and health care rationing: an exploratory study using qualitative methods

Area of Science:

• Health policy
• Decision science
• Sociology of health

Background:

• The principal-agent theory is applied to societal healthcare decision-making.
• Ambiguity exists regarding citizen-agent relationships in healthcare rationing.
• Little research explores citizen preferences for agents in healthcare decisions.

Purpose of the Study:

• To explore the citizen-agent relationship in societal healthcare decision-making.
• To understand citizen willingness to delegate rationing decisions to agents.
• To identify potential societal agents for healthcare rationing.

Main Methods:

• Qualitative approach utilizing semi-structured interviews.
• Data collected from both citizens and potential healthcare agents.
• Analysis performed using constant comparison methodology.

Main Results:

• Citizen involvement in rationing decisions varies significantly based on knowledge, experience, and distress.
• Agents perceive citizens as needing delegation for decision-making.
• Health authorities are viewed as the primary agents for rationing decisions.
• The citizen-agent relationship in healthcare is complex and imperfect.
• Decisions result from interactions between various actors' utility functions.
• A system of equivocation may emerge to avoid the distress of denying care.

Conclusions:

• Citizen preferences for healthcare rationing involvement are diverse.
• Healthcare agents see a need for delegation, with health authorities as key decision-makers.
• The citizen-agent dynamic in healthcare is intricate, influenced by multiple stakeholder interests.
• Societal or citizen-led rationing decisions may have limited impact due to collusion and avoidance of difficult choices.