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Health care rationing: the public's debate
1Centre for Health Informatics and Multiprofessional Education (CHIME), University College London Medical School, Whittington Hospital, UK.
Objective:
To elicit the views of a large nationally representative sample of adults on priorities for health services.
Design:
An interview survey based on a random sample of people aged 16 and over in Great Britain taken by the Office of Population Censuses and Surveys.
Subjects:
The response rate to the survey was 75%, and the total number of adults interviewed was 2005.
Main Outcome Measures:
A priority ranking exercise of health services supplemented with attitude questions about priorities, who should set priorities, and budget allocation.
Results:
The results of the main priority ranking exercise of 12 health services showed that the highest priority (rank 1) was accorded to "treatments for children with life threatening illness," the next highest priority (rank 2) was accorded to "special care and pain relief for people who are dying." The lowest priorities (11 and 12) were given to "treatment for infertility" and "treatment for people aged 75 and over with life threatening illness." Most respondents thought that surveys like this one should be used in the planning of health services.
Conclusions:
The public prioritise treatments specifically for younger rather than older people. There is some public support for people with self inflicted conditions (for example, through tobacco smoking) receiving lower priority for care, which raises ethical issues.