The Relevance of Personal Characteristics in Health Care Rationing: What the Australian Public Thinks and Why

Article excerpt

Introduction

With the increasing pressure placed on public health systems through-out the developed world (e.g., by aging populations)--shadowed by similar trends in newly industrializing nations--policy makers have accepted that rationing is inevitable. Faced with this inevitability, and the increasing trend to include the general public in decision making (Litva et al. 2002; Mossialos and King 1999), the question arises whether the public is prepared to accept that some groups of patients should get priority over others according to their personal characteristics. A useful survey of previous studies is provided by Dolan and Shaw (2001) and summarized in Olsen et al. (2003). Some 12 studies were identified from relevant bibliographic databases with the aim of exploring how respondents view the status of personal characteristics as a criterion for setting priorities in health care. The study by Olsen et al. (2003) is notable for its identification and classification of the ethical justifications revealed by survey respondents across the 12 empirical studies. The authors distinguish between characteristics that pertain to a patient's relations to other people in society (e.g., marital status, employment status), characteristics that bear on the cause of the illness (e.g., smoking, alcohol abuse), and characteristics that are intrinsic "in a person's self physically, intellectually or attitudinally" (e.g., gender, race) (Olsen et al. 2003: 1164). A subsequent expanded literature review by Dolan et al. (2005) summarized results from 64 empirical studies, but the conclusions, albeit representative of a greater range of topics, are not substantially different.

In this article we further examine the relevance of (potential) patients' personal characteristics as a basis for health care resource allocation. Data are drawn from the Monash Health and Social Values Survey. It differs from other studies in placing the emphasis on explaining the public's preferences. Just what is it that influences how and why an individual would ration health care according to some personal characteristic(s) of the prospective beneficiaries? Is it an issue that is pre-eminently political? That is, is health care rationing a subset of overall social objectives? Or are these preferences primarily influenced by ethical or religious views? Or is it related to patterns of decisions inherently grounded in personality type? Perhaps the experience and extent of one's social networks has an effect on how an individual views the relevance of particular characteristics? Do respondents only consider the clinical evidence or are other factors involved? The examination of the personal and demographic characteristics of respondents might be expected to answer some of these questions.

Methods, Data Source, and Participants

The Monash Health and Social Values Survey was conducted during 2006 and 2007. Since the central aim of the survey was to enhance explanation, we sought to maximize overall survey numbers in order to allow the accurate inference of the views of a wide spread of groups. In other words, the objective of establishing population parameter estimates was subsidiary to obtaining sufficient numbers from representative sub-groups. The survey aimed for maximum information from maximum numbers with minimal follow up per respondent, accepting that the burden of data to be collected may result in a small response rate.

It was a feature of the project that it made a serious effort to enlist a cooperative partnership with potential respondents. Thus, randomly chosen members of the public were first sent a letter inviting them to participate in the survey, indicating that there would be two separate questionnaires several months apart. As it turned out, respondents were in fact asked to complete a third survey. This method facilitated inter-survey modifications of the design of the second and third questionnaires prompted by the nature of results from the first. …