Priority setting in health care: Attitudes of physicians and patients

Background: The opinion of physicians clearly counts in prioritizing health care, but there is little information on the rationales underlying treatment decisions and whether these rationales are accepted by patients. Objective: To compare physicians and patients regarding their understanding and use of therapeutic benefit and treatment costs as criteria for prioritizing health care. Methods: Seven physicians and twelve patients were purposefully selected to yield a heterogeneous sample. Participants were interviewed face-to-face, following a semi-structured topic guide comprising three scenarios that focused on interventions with low or unproven therapeutic benefit and high costs, respectively. For data analysis we used qualitative content analysis. Results: We found that patients and physicians differed in their understanding of therapeutic benefit, their expectations of what medicine can do and their use of costs as criteria for prioritizing health care. Physicians were less likely to assess a certain intervention as effective, and they less often accepted upper funding limits in health care. Unlike the physicians, patients raised non-medical aspects in decision making such as the patient’s consent and social inequalities. Conclusions: The revealed differences point toward the necessity to strengthen the doctor-patient communication, to improve information for patients about the possibilities and limits of health care and to gain a deeper understanding of their attitudes, wishes and concerns to reach an agreement by physicians and patients on the treatment to be implemented.