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Madeira F, Do Bú EA, Freitas G, Pereira CR. Distributive justice criteria and social categorization processes predict healthcare allocation bias. Br J Health Psychol 2022; 28:552-566. [PMID: 36504178 DOI: 10.1111/bjhp.12640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/16/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Drawing on theories of distributive justice and intergroup discrimination, we examined how much distributive justice criterion and racial group membership contribute to bias in healthcare allocation decisions, by testing a theoretical model that specifies perceived stereotypicality and individual responsibility as a serial mediation process in the relationship between disease's contraction controllability (controllable vs. non-controllable) and bias in medical decision-making. METHOD White Portuguese medical students (N = 213) participated in an online experimental study conducted in two phases. In phase 1, we manipulated the cause of disease contagion and the salience of patient's racial categorization, and measured the stereotypicality of behaviour. In phase 2, we assessed perceived responsibility and likelihood of recommending medical treatment. RESULTS Controllable (vs. non-controllable) contraction behaviours in phase 1 were perceived as more stereotypic. As a spillover effect, more stereotypical behaviours in phase 1 predicted more patient's responsibility for their disease in phase 2. Importantly, controllable behaviours of disease contraction in phase 1 negatively affected recommendations for medical treatment in phase 2; and this negative effect was serially mediated by the stereotypicality of behaviour and patient responsibility. Furthermore, patients' skin colour moderated this process, meaning that perceptions of controllable behaviour as more stereotypic were stronger for Black than for White patients. CONCLUSIONS This research shows how stereotyping and social categorization bias allocation decisions through the patient's level of responsibility in decision-making processes. The findings are discussed in light of principles of distributive justice and the literature on intergroup relations with respect to racial disparities in health care.
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Affiliation(s)
- Filipa Madeira
- Institute of Social Sciences University of Lisbon Lisbon Portugal
| | - Emerson Araújo Do Bú
- Institute of Social Sciences University of Lisbon Lisbon Portugal
- Faculty of Psychology University of Lisbon Lisbon Portugal
| | - Gonçalo Freitas
- Institute of Social Sciences University of Lisbon Lisbon Portugal
- Faculty of Psychology University of Lisbon Lisbon Portugal
| | - Cicero Roberto Pereira
- Institute of Social Sciences University of Lisbon Lisbon Portugal
- Department of Psychology Federal University of Paraíba João Pessoa Brazil
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Liver transplantation in patients with alcohol-related liver disease: current status and future directions. Lancet Gastroenterol Hepatol 2020; 5:507-514. [DOI: 10.1016/s2468-1253(19)30451-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/15/2019] [Accepted: 12/19/2019] [Indexed: 12/19/2022]
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Hook CJ, Rose Markus H. Health in the United States: Are Appeals to Choice and Personal Responsibility Making Americans Sick? PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2020; 15:643-664. [DOI: 10.1177/1745691619896252] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The United States suffers high rates of preventable lifestyle disease despite widespread calls for people to take responsibility for their health. The United States also stands out in its rejection of government action to guide industry practices and consumer choices. Why? We examine how deeply rooted cultural narratives about “free choice” and “personal responsibility” infuse policymaking, advertising, media, social norms, and individual attitudes about health in the United States. We argue that these narratives contribute to ill health in the United States: They encourage stress and worry over health, blame and stigmatization of the unhealthy, widened health disparities, and the failure to adopt policies that could save lives. Psychologists can play a major role in expanding narratives about health so that they include the role of personal choice and responsibility but also reflect current science about the physical, social, and cultural drivers of health. These broader narratives can be used to promote a more comprehensive understanding of health and to better inform the design, communication, and implementation of effective health-supportive policies.
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Traina G, Martinussen PE, Feiring E. Being Healthy, Being Sick, Being Responsible: Attitudes towards Responsibility for Health in a Public Healthcare System. Public Health Ethics 2019; 12:145-157. [PMID: 31384303 PMCID: PMC6655377 DOI: 10.1093/phe/phz009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Lifestyle-induced diseases are becoming a burden on healthcare, actualizing the discussion on health responsibilities. Using data from the National Association for Heart and Lung Diseases (LHL)’s 2015 Health Survey (N = 2689), this study examined the public’s attitudes towards personal and social health responsibility in a Norwegian population. The questionnaires covered self-reported health and lifestyle, attitudes towards personal responsibility and the authorities’ responsibility for promoting health, resource-prioritisation and socio-demographic characteristics. Block-wise multiple linear regression assessed the association between attitudes towards health responsibilities and individual lifestyle, political orientation and health condition. We found a moderate support for social responsibility across political views. Respondents reporting unhealthier eating habits, smokers and physically inactive were less supportive of health promotion policies (including information, health incentives, prevention and regulations). The idea that individuals are responsible for taking care of their health was widely accepted as an abstract ideal. Yet, only a third of the respondents agreed with introducing higher co-payments for treatment of ‘self-inflicted’ conditions and levels of support were patterned by health-related behaviour and left-right political orientation. Our study suggests that a significant support for social responsibility does not exclude a strong support for personal health responsibility. However, conditional access to healthcare based on personal lifestyle is still controversial.
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Affiliation(s)
- Gloria Traina
- Department of Health Management and Health Economics, University of Oslo
| | - Pål E Martinussen
- Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU)
| | - Eli Feiring
- Department of Health Management and Health Economics, University of Oslo
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Contemporary Policies Regarding Alcohol and Marijuana Use Among Liver Transplant Programs in the United States. Transplantation 2018; 102:433-439. [PMID: 29019813 DOI: 10.1097/tp.0000000000001969] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Alcoholic liver disease is a common indication for orthotopic liver transplantation (OLT). Although OLT has been shown to confer survival benefit to patients with acute alcoholic hepatitis (AAH), historically most programs require a 6-month abstinence period before OLT which excludes patients with AAH. Marijuana has become legal in more than half the states in the United States. This survey of liver transplant programs was conducted to evaluate current policies regarding alcohol, marijuana and methadone use. METHODS A questionnaire was distributed to 100 United Network for Organ Sharing-approved liver transplant programs in North America that have performed at least 30 liver transplants/year in the last 5 years. RESULTS Forty-nine programs responded. Only 43% of the programs required a specific period of abstinence before transplant for alcoholic liver disease and only 26% enforced 6-month abstinence policy. For patients with AAH, 71% programs waived the 6-month abstinence requirement and considered psychosocial factors, such as family support, patient's motivation, or commitment to rehabilitate. Few programs used validated instruments to assess risk of relapse in AAH patients. Fourteen percent of programs transplant patients actively using marijuana and an additional 28% of programs listed patients using marijuana provided they discontinue by the time of OLT. Active methadone users were accepted in 45% of the programs. CONCLUSIONS Policies regarding alcohol use have become more flexible particularly toward patients with AAH. Marijuana use is also more accepted. Although policies regarding alcohol and marijuana have changed significantly in the last decade, they remain highly variable among programs.
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EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. J Hepatol 2018; 69:154-181. [PMID: 29628280 DOI: 10.1016/j.jhep.2018.03.018] [Citation(s) in RCA: 477] [Impact Index Per Article: 79.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 12/12/2022]
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Dewitt B, Davis A, Fischhoff B, Hanmer J. An Approach to Reconciling Competing Ethical Principles in Aggregating Heterogeneous Health Preferences. Med Decis Making 2017; 37:647-656. [PMID: 28453945 DOI: 10.1177/0272989x17696999] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Health-related quality of life (HRQL) scores are used extensively to quantify the effectiveness of medical interventions. Societal preference-based HRQL scores aim to produce societal valuations of health by aggregating valuations from individuals in the general population, where each aggregation procedure embodies different ethical principles, as explained in social choice theory. METHODS Using the Health Utilities Index as an exemplar, we evaluate societal preference-based HRQL measures in the social choice theory framework. RESULTS We find that current preference aggregation procedures are typically justified in terms of social choice theory. However, by convention, they use only one of many possible aggregation procedures (the mean). Central to the choice of aggregation procedure is how to treat preference heterogeneity, which can affect analyses that rely on HRQL scores, such as cost-effectiveness analyses. We propose an analytical-deliberative framework for choosing one (or a set of) aggregation procedure(s) in a socially credible way, which we believe to be analytically sound and empirically tractable, but leave open the institutional mechanism needed to implement it. CONCLUSIONS Socially acceptable decisions about aggregating heterogeneous preferences require eliciting stakeholders' preferences among the set of analytically sound procedures, representing different ethical principles. We describe a framework for eliciting such preferences for the creation of HRQL scores, informed by social choice theory and behavioral decision research.
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Affiliation(s)
- Barry Dewitt
- Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA (BD, AD)
| | - Alexander Davis
- Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA (BD, AD)
| | - Baruch Fischhoff
- Department of Engineering and Public Policy and the Institute for Politics and Strategy, Carnegie Mellon University, Pittsburgh, PA, USA (BF)
| | - Janel Hanmer
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA (JH)
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Abstract
Excessive alcohol use is a common health care problem worldwide and is associated with significant morbidity and mortality. Alcoholic liver disease represents the second most frequent indication for liver transplantation in North America and Europe. The pretransplant evaluation of patients with alcoholic liver disease should aim at identifying those at high risk for posttransplant relapse of alcohol use disorder, as return to excessive drinking can be deleterious to graft and patient survival. Carefully selected patients with alcoholic liver disease, including those with severe alcoholic hepatitis, will have similar short-term and long-term outcomes when compared with other indications for liver transplantation.
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Vidal-Trécan G, Kone V, Pilette C, Nousbaum JB, Doll J, Buffet C, Eugene C, Podevin P, Boutet O, Puyeo J, Conti F, Calmus Y. Subjective parameters markedly limit the referral of transplantation candidates to liver transplant centres. Liver Int 2016; 36:555-62. [PMID: 26604165 DOI: 10.1111/liv.13030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 11/12/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS Equality of access to organ transplantation is a mandatory public health requirement. Referral from a local to a university hospital and then registration on the national waiting list are the two key steps enabling access to liver transplantation (LT). Although the latter procedure is well defined using the Model for End-stage Liver Disease score that improves equality of access, the former is mostly reliant on the practices of referring physicians. The aim of this study was to clarify the factors determining this initial step. METHODS This observational study included consecutive inpatients with cirrhosis of whatever origin in a cohort constituted between 2003 and 2008, using medical records and structured questionnaires concerning patient characteristics and the opinions of hospital clinicians. Candidates for LT were defined in line with these opinions. RESULTS Four hundred and thirty-three patients, mostly affected by alcoholic cirrhosis, were included, 21.0% of whom were considered to be candidates for LT. Factors independently associated with their candidature were: physician empathy [odds ratio (OR) = 10.8; 95% CI: 4.0-29.5], adherence to treatment (OR = 16.6; 95% CI: 3.7-75.2), geographical area (OR = 6.8; 95% CI: 2.2-21.3) and the patient's physiological age (OR = 2.3; 95% CI: 1.1-4.7). CONCLUSIONS Several subjective markers restrict the referral of patients from local hospitals to liver transplant centres. Their advancement to this second step is thus markedly weakened by initial subjectivity. The development of objective guidelines for local hospital physicians to assist them with their initial decision-making on LT is now necessary.
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Affiliation(s)
- Gwenaëlle Vidal-Trécan
- Public Health Unit: Risk Management and Quality of Care, Paris Centre University Hospital Group, AP-HP, Paris, France.,Department of Public Health, Faculty of Medicine, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Research Unit (INSERM U1153) Methods Team, Methods of Therapeutic Evaluation of Chronic Diseases, Research Center Epidemiology and Biostatistics, Sorbonne Paris Cité, Paris, France
| | - Victoria Kone
- Public Health Unit: Risk Management and Quality of Care, Paris Centre University Hospital Group, AP-HP, Paris, France
| | | | | | - Jacques Doll
- Hepatogastroenterology Department, CHG de Versailles, Versailles, France
| | - Catherine Buffet
- Hepatogastroenterology Department, CHU Kremlin Bicètre, Kremlin Bicètre, France
| | - Claude Eugene
- Hepatogastroenterology Department, CHG de Poissy, Poissy, France
| | - Philippe Podevin
- Centre de Reference en Addictologie, Pitie-Salpetriere Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Olivier Boutet
- Hepatogastroenterology Department, CHG de Bagnoles sur Cèze, Bagnoles sur Cèze, France
| | - Jacques Puyeo
- Hepatogastroenterology Department, CHG de Carcassonne, Carcassonne, France
| | - Filomena Conti
- Centre de Transplantation Hepatique, Pitie-Salpetriere Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Yvon Calmus
- Centre de Transplantation Hepatique, Pitie-Salpetriere Hospital, AP-HP, Paris Descartes University, Paris, France
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Stroh G, Rosell T, Dong F, Forster J. Early liver transplantation for patients with acute alcoholic hepatitis: public views and the effects on organ donation. Am J Transplant 2015; 15:1598-604. [PMID: 25707427 DOI: 10.1111/ajt.13176] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 12/07/2014] [Accepted: 12/21/2014] [Indexed: 01/25/2023]
Abstract
Patients with severe acute alcoholic hepatitis may not survive to fulfill the standard 6 months of abstinence and counseling prior to transplantation. A prospective study demonstrated that early liver transplantation in such patients improved 2 year survival from 23% to 71% and only 3 of 26 patients returned to drinking after 1140 days; graft function was unaffected. Nonetheless, this treatment protocol may raise public concerns and affect organ donation rates. A total of 503 participants took a survey made available at an online crowdsourcing marketplace. The survey measured attitudes on liver transplantation generally and early transplantation for this patient population, in addition to measuring responses to nine vignettes describing fictional candidates. The majority of respondents (81.5%, n = 410) was at least neutral toward early transplantation for these patients; only a minority (26.3%) indicated that transplantation in any vignette would make them hesitant to donate their organs. Middle-aged patients with good social support and financial stability were viewed most favorably (p < 0.001). Age was considered the most important selection factor and financial stability the least important factor (each p < 0.001). Results indicate early transplantation for carefully selected patients with acute alcoholic hepatitis may not be as controversial to the public as previously thought.
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Affiliation(s)
- G Stroh
- University of Kansas School of Medicine, Kansas City, KS
| | - T Rosell
- Department of History and Philosophy of Medicine, University of Kansas Medical Center, Kansas City, KS
| | - F Dong
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - J Forster
- Saint Luke's Transplant Specialists, Saint Luke's Health System, Kansas City, MO
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Mason H, Baker R, Donaldson C. Understanding public preferences for prioritizing health care interventions in England: does the type of health gain matter? J Health Serv Res Policy 2011; 16:81-9. [PMID: 21447843 DOI: 10.1258/jhsrp.2010.010039] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Health care budgets are finite and decisions must be made about which interventions to provide and, by implication, which will not be provided. The aim of this study was to investigate what features of health care interventions, including the type of health gain, are important to members of the public in England in making priority-setting decisions and to understand why. METHODS Q methodology was used with 52 members of the public in north east England. Respondents rank ordered 36 health care interventions from those they would give highest priority to through to those they would give lowest priority to. A form of factor analysis was used to reveal a small number of shared viewpoints. RESULTS Five factors emerged: 'life saving to maximize the size of the health gain', 'everyone deserves a chance at life', '(potential for) own benefit', 'maximum benefit for (perceived) lowest cost' and 'quality of life and social responsibility'. There were different views about which interventions should be given priority. Respondents considered not only the type of health gain received from an intervention as important, but also the size of the health gain, who received the health gain and an individual's personal responsibility. CONCLUSIONS Aspects other than health gain need to be considered when soliciting the public's views of priorities for health care interventions.
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Affiliation(s)
- Helen Mason
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
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Affiliation(s)
- Christina Dineen
- Birkbeck College, University of London, Department of Philosophy, Malet Street, London, United Kingdom.
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Bosworth R, Cameron TA, DeShazo J. Is an Ounce of Prevention Worth a Pound of Cure? Comparing Demand for Public Prevention and Treatment Policies. Med Decis Making 2010; 30:E40-56. [DOI: 10.1177/0272989x10371681] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Public policy can affect the allocation of resources between programs designed to prevent illnesses or injuries and programs designed to treat those who are already sick or injured. Information about preferences for treatment and prevention policies can help policy makers more effectively allocate public health resources among alternative uses. Our objective is to assess preferences for publicly funded health policies designed to prevent or treat major health threats. We use national surveys that employ discrete choice experiment formats. The surveys allow respondents to make trade-offs between policies designed to prevent or treat most major health threats. The surveys were administered to a nationally representative sample of over 3000 respondents. Methods. We estimate a random utility model of preferences for treatment and prevention policies and explore sources of systematic heterogeneity in preferences. Results. We estimate marginal utility associated with avoided deaths to be about twice as high for prevention policies as for treatment policies and find statistically significant heterogeneity with respect to disease type, the group targeted by the policy, and respondent characteristics. Conclusions. Preferences for public health policies vary markedly with policy attributes and with individual characteristics. Benefits measurements for welfare assessments of public health policies should be tailored to the type of health threat and the characteristics of the affected population.
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Affiliation(s)
- Ryan Bosworth
- Department of Applied Economics, Utah State University, Logan, UT,
| | | | - J.R. DeShazo
- Department of Public Policy, School of Public Affairs, University of California, Los Angeles, CA
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Perut V, Conti F, Scatton O, Soubrane O, Calmus Y, Vidal-Trecan G. Might physicians be restricting access to liver transplantation for patients with alcoholic liver disease? J Hepatol 2009; 51:707-14. [PMID: 19665248 DOI: 10.1016/j.jhep.2009.04.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Revised: 03/16/2009] [Accepted: 04/29/2009] [Indexed: 12/14/2022]
Abstract
BACKGROUND/AIMS In France, the most common cause of cirrhosis is excessive alcohol consumption. Post-transplant survival rates in patients with alcoholic liver disease (ALD) are at least as good as those seen with other indications. However, fewer of these patients are found on the waiting list. To understand the reasons for this discrepancy, it was decided to examine physicians' attitudes concerning the allocation of deceased donor liver allografts. METHODS Using a standardized postal questionnaire, 1739 physicians were asked to allocate 100 liver transplants to two competing groups of patients who were equivalent except for the cause of their cirrhosis (i.e. alcohol-related or primary biliary cirrhosis). A composite score was then used to assess their attitude regarding the behavior of alcoholics and their responsibility for their illness. RESULTS Among the 475 respondents (response rate: 27.3%), 55.2% allocated fewer than 50 transplants to ALD patients. This lower rate was independently associated with factors such as being a general practitioner (odds ratio [OR]=3.2, 95% confidence interval [95%CI]=1.8-5.9), a misinterpretation of ALD patients being equivalent to others (OR=1.8, 95%CI=1.1-3.0) or unfavorable attitudes regarding alcoholics (OR=4.0, 95%CI=1.7-9.5, to OR=126.8, 95%CI=34.0-472.1). CONCLUSIONS Greater information and education of physicians may improve access to liver transplantation for ALD patients.
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Affiliation(s)
- Valérie Perut
- Unité de Gestion des Risques et Qualité, Groupe hospitalier Cochin-Saint Vincent de Paul, AP-HP, Paris, France
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Kasemsup V, Schommer JC, Cline RR, Hadsall RS. Citizen's preferences regarding principles to guide health-care allocation decisions in Thailand. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2008; 11:1194-1202. [PMID: 18494755 DOI: 10.1111/j.1524-4733.2008.00321.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES The objective of this study was to investigate the extent to which five principles of rationing (lottery, rule of rescue, health maximization, fair innings, and choicism) were preferred by a sample of Thai citizens for selecting patients to receive high-cost therapies. METHODS A self-administered survey was used for collecting data from a sample of 1000 individuals living in Thailand. Descriptive statistics, factor analysis, and multinomial logistic regression analysis were used for describing and validating the data. Out of the 1000 sample members, 780 (78%) provided usable responses. RESULTS The results showed that within specific situations under budget constraints, Thai people used each of the criteria we studied to ration health care including: 1) lottery principle; 2) rule of rescue; 3) health maximization; 4) fair innings; and 5) choicism. CONCLUSIONS The extent to which the criteria were applied depended on the specific situation placed before the decision-maker. "Choicism" (equalizing opportunity for health) was the most preferred method for rationing when compared to each of the other four principles.
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Affiliation(s)
- Vijj Kasemsup
- Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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