Professor, Department of Clinical Epidemiology & Biostatistics, Centre for Health Economics & Policy Analysis, McMaster University, Hamilton, ONProfessor, Department of Economics, McMaster University, Hamilton, ONDoctoral Candidate, Health Research Methodology Program, McMaster University, Hamilton, ON, Canada.
Health Expect. 2014 Apr;17(2):174-85. doi: 10.1111/j.1369-7625.2011.00751.x. Epub 2012 Mar 6.
To investigate how participants in an economic resource allocation survey construct notions of fairness.
Qualitative interview study guided by interpretive grounded theory methods.
Qualitative interviews were conducted with volunteer university- (n=39) and community-based (n =7) economic survey participants. INTERVENTION OR MAIN VARIABLES STUDIED: We explored how participants constructed meanings to guide or explain fair survey choices, focusing on rationales, imagery and additional desired information not provided in the survey scenarios.
Data were transcribed and coded into qualitative categories. Analysis iterated with data collection iterated through three waves of interviews.
Participants compared the survey dilemmas to domains outside the health system. Most compared them with other micro-level, inter-personal sharing tasks. Participants raised several fairness-relevant factors beyond need or capacity to benefit. These included age, weight, poverty, access to other options and personal responsibility for illness; illness duration, curability or seriousness; life expectancy; possibilities for sharing; awareness of other's needs; and ability to explain allocations to those affected. They also articulated a fairness principle little considered by equity theories: that everybody must get something and nobody should get nothing.
Lay criteria for judging fairness are myriad. Simple scenarios may be used to investigate lay commitments to abstract principles. Although principles are the focus of analysis and inference, participants may solve simplified dilemmas by imputing extraneous features to the problem or applying unanticipated principles. These possibilities should be taken into account in the design of resource allocation surveys eliciting the views of the public.
调查经济资源分配调查参与者如何构建公平观念。
定性访谈研究，以解释性扎根理论方法为指导。
对志愿参加大学（n=39）和社区（n=7）经济调查的参与者进行了定性访谈。
我们探讨了参与者如何构建意义来指导或解释公平调查选择，重点关注理性、意象和调查情景中未提供的其他所需信息。
数据转录并编码为定性类别。分析与数据收集迭代进行，通过三波访谈进行迭代。
参与者将调查困境与卫生系统之外的领域进行了比较。大多数人将其与其他微观层面、人际共享任务进行了比较。参与者提出了一些超出受益能力或需求的公平相关因素。这些因素包括年龄、体重、贫困、获得其他选择的机会和个人对疾病的责任；疾病持续时间、可治愈性或严重性；预期寿命；共享的可能性；对他人需求的认识；以及向受影响者解释分配的能力。他们还阐明了公平原则：每个人都必须得到一些东西，没有人应该一无所有。这一原则很少被公平理论所考虑。
判断公平的标准有很多。简单的情景可以用来调查人们对抽象原则的承诺。虽然原则是分析和推断的重点，但参与者可能会通过将无关特征归因于问题或应用意外原则来解决简化的困境。在设计征求公众意见的资源分配调查时，应考虑到这些可能性。
