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How do financial considerations influence medical decision-making? A qualitative-empirical study in German cancer
Julia Felicitas Leni König1,2, Birthe Aufenberg3, Gereon Brei3
1National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg University, Medical Faculty Heidelberg, Department of Medical Oncology, Section Translational Medical Ethics, Heidelberg University Medical Faculty Heidelberg, Heidelberg, Germany.
Introduction:
The question of how financial considerations influence medical decision-making is coming to a head in cancer medicine, as cancer medicine is getting more expensive and extensive. As the debate continues, empirical data on specific decision-making situations that are influenced by financial consideration and on the characterisation of financial influence in cancer medicine remain scarce.
Methods:
We conducted a qualitative semistructured interview study with physicians who had experience in controlling and budgeting in different settings of cancer care in Germany. Qualitative content analysis was performed to identify specific decision-making situations in cancer medicine influenced by financial considerations and to characterise the financial influence.
Results:
n=16 interviews were conducted. We identified 21 medical decision-making situations influenced by financial considerations specific to cancer medicine, which were characterised into four subcategories of financial influence derived from the data: (1) no reimbursement, (2) reimbursement that does not completely cover costs, (3) reimbursement that exceeds the costs and (4) costs covered for treatments with questionable cost-effectiveness. These results imply that medical decisions in cancer medicine could be influenced by financial considerations.
Conclusions:
The findings support the hypothesis that medical decision-making in cancer medicine can be influenced by financial considerations. They provide specific examples and a characterisation of the influence as starting points for further quantitative studies on the extent of the financial influence and on the possible effect on high-risk patient groups. Further, they underline the need for ethical analysis regarding the implications for quality of care.
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