谁应该接受治疗？社会观点与医疗保健优先排序偏好之间关系的实证研究
Who should receive treatment? An empirical enquiry into the relationship between societal views and preferences concerning healthcare priority setting.
机构信息
Erasmus University Rotterdam, Erasmus School of Health Policy & Management, Rotterdam, the Netherlands.
Erasmus University Rotterdam, Erasmus School of Economics, Rotterdam, the Netherlands.
出版信息
PLoS One. 2018 Jun 27;13(6):e0198761. doi: 10.1371/journal.pone.0198761. eCollection 2018.
INTRODUCTION
Policy makers increasingly need to prioritise between competing health technologies or patient populations. When aiming to align allocation decisions with societal preferences, knowledge and operationalisation of such preferences is indispensable. This study examines the distribution of three views on healthcare priority setting in the Netherlands, labelled "Equal right to healthcare", "Limits to healthcare", and "Effective and efficient healthcare", and their relationship with preferences in willingness to trade-off (WTT) exercises.
METHODS
A survey including four reimbursement scenarios was conducted in a representative sample of the adult population in the Netherlands (n = 261). Respondents were matched to one of the three views based on their agreement with 14 statements on principles for resource allocation. We tested for WTT differences between respondents with different views and applied logit regression models for examining the relationship between preferences and background characteristics, including views.
RESULTS
Nearly 65% of respondents held the view "Equal right to healthcare", followed by "Limits to healthcare" (22.5%), and "Effective and efficient healthcare" (7.1%). Most respondents (75.9%) expressed WTT in at least one scenario and preferred gains in quality of life over life expectancy, maximising gains over limiting inequality, treating children over elderly, and those with adversity over those with an unhealthy lifestyle. Various background characteristics, including the views, were associated with respondents' preferences.
CONCLUSIONS
Most respondents held an egalitarian view on priority setting, yet the majority was willing to prioritise regardless of their view. Societal views and preferences concerning healthcare priority setting are related. However, respondents' views influence preferences differently in different reimbursement scenarios. As societal views and preferences are heterogeneous and may conflict, aligning allocation decisions with societal preferences remains challenging and any decision may be expected to receive opposition from some group in society.
简介
政策制定者越来越需要在相互竞争的卫生技术或患者群体之间进行优先排序。当旨在使分配决策与社会偏好保持一致时，了解和实施这些偏好是必不可少的。本研究考察了荷兰三种医疗保健优先排序观点的分布情况，这三种观点分别是“医疗保健平等权利”、“医疗保健限制”和“高效能医疗保健”，并研究了它们与权衡意愿（WTT）练习中的偏好之间的关系。
方法
在荷兰代表性成年人样本中进行了一项包括四个报销方案的调查（n=261）。根据他们对资源分配原则的 14 项声明的同意程度，将受访者与三种观点之一进行匹配。我们测试了不同观点的受访者之间的 WTT 差异，并应用逻辑回归模型来检验偏好与背景特征（包括观点）之间的关系。
结果
近 65%的受访者持“医疗保健平等权利”观点，其次是“医疗保健限制”（22.5%）和“高效能医疗保健”（7.1%）。大多数受访者（75.9%）在至少一个方案中表达了 WTT，并倾向于在生活质量方面获得收益而不是在预期寿命方面，在获得收益方面最大化而不是限制不平等，在治疗儿童方面优先于治疗老年人，以及在治疗逆境方面优先于治疗不健康生活方式。各种背景特征，包括观点，与受访者的偏好相关。
结论
大多数受访者对优先排序持平等主义观点，但大多数人愿意优先排序，而不考虑他们的观点。社会对医疗保健优先排序的看法和偏好是相关的。然而，受访者的观点在不同的报销方案中对偏好的影响不同。由于社会观点和偏好是多样化的，并且可能存在冲突，因此使分配决策与社会偏好保持一致仍然具有挑战性，任何决策都可能会引起社会某些群体的反对。
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