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[Financial limits to care; a survey among physicians]
M W Wouters1, D R Timmermans, J Kievit
1Rijksuniversiteit, faculteit der Geneeskunde, sectie Medische Besliskunde, Leiden.
Objective:
To determine physicians' opinions about the role of cost considerations in treatment decisions.
Design:
Oral inquiry.
Setting:
Hospitals in the area of Leiden and Amsterdam, the Netherlands.
Methods:
82 medical specialists (41 surgeons and 41 internists) were interviewed and answered questions regarding cost considerations in medical care. They were also asked to determine the probability of success below which they considered an expensive medical treatment useless.
Results:
The respondents agreed that the government can set limits to care and incorporate cost considerations, but they also indicated that the role of physicians is to treat individual patients. About half the physicians would agree to discontinue treatment when it became too expensive. Decisions regarding the limitation of care should be made by politicians with or without the advice of physicians. The respondents would discontinue (an expensive) treatment (in a presented case) if the probability of success was on average below 12%, but half the physicians said they would accept a lower probability of success for individual patients than they would recommend as a policy.
Conclusion:
Although physicians agreed about the necessity to set limits to medical care, their behaviour in clinical practice appeared to be not always in agreement with this.