Domestic Research and Evaluation, American Institutes for Research, Chapel Hill, NC, USA.
Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA.
J Gen Intern Med. 2017 Dec;32(12):1396-1402. doi: 10.1007/s11606-017-4172-1. Epub 2017 Sep 5.
Decision makers are increasingly tasked with reducing health care costs, but the public may be mistrustful of these efforts. Public deliberation helps gather input on these types of issues by convening a group of diverse individuals to learn about and discuss values-based dilemmas.
To explore public perceptions of health care costs and how they intersect with medical mistrust.
This mixed-methods study analyzed data from a randomized controlled trial including four public deliberation groups (n = 96) and a control group (n = 348) comprising English-speaking adults aged 18 years and older. Data were collected in 2012 in four U.S. regions.
We used data from four survey items to compare attitude shifts about costs among participants in deliberation groups to participants in the control group. We qualitatively analyzed deliberation transcripts to identify themes related to attitude shifts and to provide context for quantitative results about attitude shifts.
Deliberation participants were significantly more likely than control group participants to agree that doctors and patients should consider cost when making treatment decisions (β = 0.59; p < 0.01) and that people should consider the effect on group premiums when making treatment decisions (β = 0.48; p < 0.01). Qualitatively, participants mistrusted the health care system's profit motives (e.g., that systems prioritize making money over patient needs); however, after grappling with patient/doctor autonomy and learning about and examining their own views related to costs during the process of deliberation, they largely concluded that payers have the right to set some boundaries to curb costs.
Individuals who are informed about costs may be receptive to boundaries that reduce societal health care costs, despite their mistrust of the health care system's profit motives, especially if decision makers communicate their rationale in a transparent manner. Future work should aim to develop transparent policies and practices that earn public trust.
决策者越来越多地面临降低医疗成本的任务，但公众可能对这些努力持不信任态度。公众讨论通过召集一组不同的个体来了解和讨论基于价值观的困境，有助于收集这些问题的意见。
探讨公众对医疗成本的看法，以及这些看法如何与医疗不信任相互交织。
这项混合方法研究分析了一项随机对照试验的数据，该试验包括四个公众讨论小组（n=96）和一个对照组（n=348），由年龄在 18 岁及以上的讲英语的成年人组成。数据于 2012 年在四个美国地区收集。
我们使用了来自四个调查项目的数据，比较了讨论组参与者和对照组参与者在成本方面的态度转变。我们对讨论记录进行了定性分析，以确定与态度转变相关的主题，并为关于态度转变的定量结果提供背景。
与对照组参与者相比，讨论组参与者更有可能同意医生和患者在做出治疗决策时应考虑成本（β=0.59；p<0.01），以及人们在做出治疗决策时应考虑对团体保险费的影响（β=0.48；p<0.01）。定性分析表明，参与者不信任医疗保健系统的盈利动机（例如，系统优先考虑盈利而不是患者的需求）；然而，在审议过程中，通过处理患者/医生自主权以及了解和检查他们自己与成本相关的观点之后，他们基本上得出结论，支付方有权设定一些界限来控制成本。
尽管公众对医疗保健系统的盈利动机持不信任态度，但如果决策者以透明的方式传达其基本原理，了解成本的个人可能会接受降低社会医疗成本的界限。未来的工作应该旨在制定透明的政策和实践，以赢得公众的信任。
