Holloway R G, Ringel S P, Bernat J L, Keran C M, Lawyer B L
Department of Neurology, University of Rochester School of Medicine and Dentistry, NY 14620-3917, USA.
Neurology. 2000 Nov 28;55(10):1492-7. doi: 10.1212/wnl.55.10.1492.
To assess neurologists' attitudes on rationing health care and to determine whether neurologists would set healthcare priorities in ways that are consistent with cost-effectiveness research.
Cost-effectiveness research can suggest ways to maximize health benefits within fixed budgets but is currently being underused in resource allocation decisions.
The authors surveyed a random sample of neurologists practicing in the United States (response rate, 44.4%) with three hypothetical scenarios. Two scenarios were designed to address general attitudes on allocating finite resources with emphasis on formulary decisions for costly drugs. The third scenario was designed to assess whether neurologists would optimize the allocation of a fixed budget as recommended by cost-effectiveness analysis.
Three-quarters of respondents thought that neurologists make daily decisions that effectively ration healthcare resources, and 60% felt a professional responsibility to consider the financial impact of individualized treatment decisions on other patients. Only 25% of respondents thought that there should be no restrictions placed on any of the five newer antiepileptic agents. In a 1995 survey, 75% of similarly sampled neurologists agreed that no restrictions should be placed on the availability of FDA-approved medications. Nearly half (46%) of respondents favored a less effective test and would be willing to let patients die to ensure the offering of a more equitable alternative.
Most neurologists recognize the need to ration health care, and although they think cost-effectiveness research is one method to achieve efficient distribution of resources, many think that considerable attention should also be given to equity.
评估神经科医生对医疗资源配给的态度，并确定神经科医生是否会以符合成本效益研究的方式设定医疗保健优先级。
成本效益研究可以提出在固定预算内最大化健康效益的方法，但目前在资源分配决策中未得到充分利用。
作者对在美国执业的神经科医生进行了随机抽样调查（回复率为44.4%），设置了三种假设情景。其中两种情景旨在探讨分配有限资源的总体态度，重点是昂贵药物的处方决策。第三种情景旨在评估神经科医生是否会按照成本效益分析的建议优化固定预算的分配。
四分之三的受访者认为神经科医生每天都在做出有效配给医疗资源的决策，60%的人感到有职业责任考虑个体化治疗决策对其他患者的经济影响。只有25%的受访者认为对五种新型抗癫痫药物中的任何一种都不应设限。在1995年的一项调查中，75%的类似抽样神经科医生同意对FDA批准药物的供应不应设限。近一半（46%）的受访者赞成采用效果较差的检测方法，并且愿意让患者死亡以确保提供更公平的替代方案。
大多数神经科医生认识到医疗资源配给的必要性，虽然他们认为成本效益研究是实现资源有效分配的一种方法，但许多人认为也应高度重视公平性。
