Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
Soc Sci Med. 2021 Mar;272:113708. doi: 10.1016/j.socscimed.2021.113708. Epub 2021 Jan 20.
To obtain public support for the active disinvestment (i.e. policy decision to stop reimbursement) of healthcare interventions, it is important to have insight in what the public thinks about disinvestment and which considerations they find relevant in this context. Currently, evidence on relevant considerations in the disinvestment context is limited. Therefore, this study aimed to explore the societal views in the Netherlands on the active disinvestment of healthcare interventions and obtain insight into the considerations that are relevant for those holding the different views.
A Q-methodology study was conducted among a purposively selected sample of citizens (n = 43). Data were collected in June and July 2019. Participants individually ranked a set of 43 statements broadly covering the issues that participants could consider relevant in the disinvestment context, from 'least agree' to 'most agree'. Qualitative feedback on the statement ranking was collected from each participant using a questionnaire. Principal component analysis followed by oblimin rotation was used to identify clusters of participants with similar statement rankings. These clusters/factors were interpreted as distinct viewpoints using the factor arrays and qualitative questionnaire responses of participants.
Four viewpoints were identified. People holding viewpoint I believe that reimbursement of necessary healthcare should be maintained, irrespective of its costs. People holding viewpoint II agree with viewpoint I, although they believe that necessity should be objectively determined. People holding viewpoint III think that unnecessary, ineffective and inefficient healthcare should be disinvested. People holding viewpoint IV, consider it most important that disinvestment decision-making processes are transparent and consistent.
Insight in the distinct viewpoints identified in this study contributes to a better understanding of why it has been considered difficult to obtain public support for disinvestment of healthcare interventions, and can help policymakers to change their approach to disinvestment to increase public support.
为了获得公众对医疗干预措施积极撤资（即停止报销的政策决定）的支持，了解公众对撤资的看法以及他们在这方面认为哪些考虑因素是相关的非常重要。目前，关于撤资背景下相关考虑因素的证据有限。因此，本研究旨在探讨荷兰社会对医疗干预措施积极撤资的看法，并深入了解对持有不同观点的人相关的考虑因素。
采用 Q 方法学对公民（n=43）进行了一项有目的抽样研究。数据于 2019 年 6 月和 7 月收集。参与者分别对一组 43 个陈述进行排名，这些陈述广泛涵盖了参与者认为在撤资背景下可能相关的问题，从“最不同意”到“最同意”。每位参与者都使用问卷对其陈述排名进行了定性反馈。采用主成分分析和 Oblimin 旋转，确定具有相似陈述排名的参与者聚类。使用因子数组和参与者的定性问卷回复，将这些聚类/因素解释为不同的观点。
确定了四个观点。持观点 I 的人认为，无论成本如何，都应维持对必要医疗保健的报销。持观点 II 的人同意观点 I，但他们认为必要性应该客观确定。持观点 III 的人认为，应撤资不必要、无效和低效的医疗保健。持观点 IV 的人认为，最重要的是撤资决策过程透明且一致。
本研究确定的不同观点的见解有助于更好地理解为什么很难获得公众对医疗干预措施撤资的支持，并可以帮助政策制定者改变撤资方法，以增加公众支持。
