Department of Health Management and Health Economics, University of Oslo, Post box 1089 Blindern, 0317, Oslo, Norway.
BMC Health Serv Res. 2020 Jun 3;20(1):497. doi: 10.1186/s12913-020-05364-6.
Concerns have been raised regarding the reasonableness of using personal health responsibility as a principle or criterion for setting priorities in healthcare. While this debate continues, little is known about clinicians' views on the role of patient responsibility in clinical contexts. This paper contributes to the knowledge on the empirical relevance of personal responsibility for priority setting at the clinical level.
A qualitative study of Norwegian clinicians (n = 15) was designed, using semi-structured interviews with vignettes to elicit beliefs on the relevance of personal responsibility as a basis for health prioritisation. Sampling was undertaken purposefully. The interviews were conducted in three hospital trusts in South-Eastern Norway between May 2018 and February 2019 and were analysed with conceptually driven thematic analysis.
The findings suggest that clinicians endorsed a general principle of personal health responsibility but were reluctant to introduce personal health responsibility as a formal priority setting criterion. Five main objections were cited, relating to avoidability, causality, harshness, intrusiveness, and inequity. Still, both retrospective and prospective attributions of personal responsibility were perceived as relevant in specific clinical settings. The most prominent argument in favour of personal health responsibility was grounded in the idea that holding patients responsible for their conduct would contribute to the efficient use of healthcare resources. Other arguments included fairness to others, desert and autonomy, but such standpoints were controversial and held only marginal relevance.
Our study provides important novel insights into the clinicians' beliefs about personal health responsibility improving the empirical knowledge concerning its fairness and potential applications to healthcare prioritisation. These findings suggest that although personal health responsibility would be difficult to implement as a steering criterion within the main priority setting framework, there might be clinical contexts where it could figure in prioritisation practices. Additional research on personal health responsibility would benefit from considering the multiple clinical encounters that shape doctor-patient relationships and that create the information basis for eligibility and prioritisation for treatment.
人们对将个人健康责任作为医疗保健优先排序的原则或标准的合理性提出了质疑。虽然这场争论仍在继续，但对于临床环境中患者责任在临床环境中的作用，人们知之甚少。本文有助于了解个人责任在临床层面上优先排序的实证相关性。
本研究采用半结构式访谈与情景模拟相结合的方法，对挪威临床医生（n=15）进行了定性研究，以了解他们对个人责任作为健康优先排序依据的相关性的看法。采用有目的抽样。访谈于 2018 年 5 月至 2019 年 2 月在挪威东南部的三个医院信托中进行，并采用概念驱动的主题分析进行分析。
研究结果表明，临床医生认可个人健康责任的一般原则，但不愿将个人健康责任作为正式的优先排序标准。提出了五个主要反对意见，涉及可避免性、因果关系、严厉性、侵入性和不公平性。尽管如此，在特定的临床环境中，个人责任的追溯和前瞻性归因都被认为是相关的。支持个人健康责任的最突出的论点是，认为让患者对自己的行为负责将有助于有效利用医疗保健资源。其他论点包括对他人的公平、应得和自主权，但这些观点存在争议，只具有边缘相关性。
我们的研究提供了有关临床医生对个人健康责任的信念的重要新见解，从而提高了有关其公平性和将其应用于医疗保健优先排序的经验知识。这些发现表明，尽管个人健康责任作为主要优先排序框架内的指导标准实施起来具有一定难度，但在某些临床环境中，它可能会在优先排序实践中发挥作用。关于个人健康责任的进一步研究，应考虑塑造医患关系并为资格和治疗优先级提供信息基础的多个临床接触。
