Hidden bedside rationing in the Netherlands: a cross-sectional survey among physicians in internal medicine

Abstract Background Healthcare rationing can be defined as withholding beneficial care for cost reasons. One form in particular, hidden bedside rationing, is problematic because it may result conflicting loyalties physicians, unfair inequality among patients and illegitimate distribution of resources. Our aim to establish whether occurs the Netherlands, qualifies what physician characteristics are associated with its practice. Methods Cross-sectional online questionnaire on knowledge -, experience opinion physicians internal medicine within Dutch healthcare system. Multivariable ordinal logistic regression was used explore relations between characteristics. Results The survey distributed 1139 across 11 hospitals a response rate 18% ( n = 203). Most participants 129; 64%) had prescribing cheaper course treatment while more effective but expensive alternative available, suggesting rationing. Subsequently, 32 (24%) never disclosed this decision their patient, qualifying hidden. majority 153; 75%) rarely discussed cost. Employment at an academic hospital independently (OR 17 95%CI 6.1–48). Furthermore, residents were likely disclose than internists 3.2, 2.1–4.7), salaried less do so private practice 0.5, 0.4–0.8). Conclusion Hidden Netherlands: patient choice occasion limited costs rationale not always disclosed. To extent should include or any other country, remains up debate.