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The meaning of severity - do citizenś views correspond to a severity framework based on ethical principles for priority setting?
Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.ORCID-id: 0000-0003-0987-7653
Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.ORCID-id: 0000-0002-3300-5516
Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
2018 (Engelska)Ingår i: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 122, nr 6, s. 630-637, artikel-id S0168-8510(18)30081-2Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

The importance for governments of establishing ethical principles and criteria for priority setting in line with social values, has been emphasised. The risk of such criteria not being operationalised and instead replaced by de-contextualised priority-setting tools, has been noted. The aim of this article was to compare whether citizenś views are in line with how a criterion derived from parliamentary-decided ethical principles have been interpreted into a framework for evaluating severity levels, in resource allocation situations in Sweden. Interviews were conducted with 15 citizens and analysed by directed content analysis. The results showed that the multi-factorial aspects that participants considered as relevant for evaluating severity, were similar to those used by professionals in the Severity Framework, but added some refinements on what to consider when taking these aspects into account. Findings of similarities, such as in our study, could have the potential to strengthen the internal legitimacy among professionals, to use such a priority-setting tool, and enable politicians to communicate the justifiability of how severity is decided. The study also disclosed new aspects regarding severity, of which some are ethically disputed, implying that our results also reveal the need for ongoing ethical discussions in publicly-funded healthcare systems.

Ort, förlag, år, upplaga, sidor
Elsevier, 2018. Vol. 122, nr 6, s. 630-637, artikel-id S0168-8510(18)30081-2
Nyckelord [en]
Citizens views, Directed content analysis, Ethical principles, Priority setting, Severity of ill health, Sweden
Nationell ämneskategori
Medicinsk etik
Identifikatorer
URN: urn:nbn:se:liu:diva-147772DOI: 10.1016/j.healthpol.2018.04.005ISI: 000438479000010PubMedID: 29728287OAI: oai:DiVA.org:liu-147772DiVA, id: diva2:1205463
Tillgänglig från: 2018-05-14 Skapad: 2018-05-14 Senast uppdaterad: 2019-06-27
Ingår i avhandling
1. Asking the public: Citizens´ views on priority setting and resource allocation in democratically governed healthcare
Öppna denna publikation i ny flik eller fönster >>Asking the public: Citizens´ views on priority setting and resource allocation in democratically governed healthcare
2018 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Resource allocation in publicly funded healthcare systems is inevitably linked with priority setting between different patient groups and between different service areas, so-called meso level priorities. Behind every priority-setting decision (investments, reallocating or rationing), are values affecting both the content of the decisions and how the decisions are made. The importance for priority-setting to reflect social values, has been emphasised for the legitimacy of the healthcare systems and the decision makers. Also important, if supposed to provide enough guidance in practice, is that content values, expressed in ethical principles and criteria, are further operationalised. Few studies exist where Swedish citizens have been asked about priority setting and rationing at meso level, and findings from other countries cannot automatically be transferred to the Swedish context.

The overall aim of this thesis is to extend and deepen the knowledge of the Swedish citizens´ views on acceptance of rationing in healthcare, on appropriate decision makers for rationing, and on the severity criterion for priority setting. Two qualitative and one mixmethod study were conducted, where citizens were interviewed. Citizens´ views on severity were also compared, both with a Severity Framework, derived from parliamentary-decided ethical principles and used for resource allocation, and with health professionals´ and politicians´ ranking of different aspects of severity in a quantitative, survey study.

Study I shows that citizen participants perceived that acceptance of rationing at meso level is built on the awareness of priority-setting dilemmas between patient groups. No such spontaneous awareness was found. Depending on reactions of self-interest or solidarity, acceptance was also perceived to be built on acceptable principles for rationing and/or access to alternatives to public care. Study II shows that awareness of the meso level forms the basis for awareness of different risks of unfairness, linked with potential decision makers (even health professionals). Collaborative arrangements were promoted in order to control for such risks, especially the risk of self-interest. Politicians, in contrast to previous studies, were favoured as final decision makers for rationing healthcare. In study III, citizen participants identified the same severity aspects as health professionals and experts had done in the Severity Framework. They contributed with some possible refinements, but also promoted aspects not in line with established ethical criteria for priority setting in Sweden. Study IV shows that citizen respondents differ to a larger proportion compared to politicians´ ranking of severity aspects, than with that of health professionals´. The greatest number of significant differences was found between politicians and health professionals.

This thesis has several implications. Politicians ought to strive for greater public awareness of the priority-setting dilemma at the meso level in healthcare, both according to the process and the content values behind the decisions. Social values not in accordance to the parliamentary decision indicate a need to facilitate an ongoing dialogue, reason-giving activities and promotion of content values of solidarity. To capture social values on priority setting and rationing, ambitious public deliberation is not the only way. Methodologically stringent research, with a variety of study designs, could contribute in many important ways.

Ort, förlag, år, upplaga, sidor
Linköping: Linköping University Electronic Press, 2018. s. 138
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1587
Nationell ämneskategori
Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi Medicinsk etik Studier av offentlig förvaltning Tvärvetenskapliga studier inom samhällsvetenskap
Identifikatorer
urn:nbn:se:liu:diva-146217 (URN)10.3384/diss.diva-146217 (DOI)9789176854518 (ISBN)
Disputation
2018-04-20, Hasselquistsalen, Campus US, Linköping, 13:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2018-04-03 Skapad: 2018-04-03 Senast uppdaterad: 2019-09-30Bibliografiskt granskad

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